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NO PERMIT NUMBER (3)
199 471 -tLyiLiis)*7- Cf LOT NO. NO. STI EET © « APPLICATION FOR PLUMBING PERMIT .i �z� ;.tom. CITY OF CUPERTINO W x a Sanitary No. n 3 Uat �` ; '",..i3 1196-9 Permit No _U Fee $ e2 S—. d W LL � Application is hereby made to the City of Cupertino for a permit to install plumbing o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices r . and/or fixtures in accordance with the provisions of the Plumbing Code of the City of a w Cupertino, and all other laws applicable thereto. Wx o Use of Premises S. 00 ' I ' I 3 Owner/jT4lq 4M—10�' S Address o a z z By CD., g� Address 0 3 625 C a`r�e0sTF112 — m Phone W an W W ¢ a State License i7/s'37 Approved WILLIAM D. BENEVICH {,, a o L. —0 �l\ PLUMBING INSPECTOR (/ FIXTURES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Water Ileater /� Z Si zc Water Closet C Material 4, Bath Tub To Curb Shower To Prop. Line Lavatories t , To Existing Kitchen Sink Not Conn. Dish Washer Sewer Box Waste Disposal Wash Tray STORM DRAINAGE Washing Machine .,� Size Water Softener Material Bar Sink To blain Drai Comb.Sink&Tray To Curb Dental Unit Drinking Fountain Floor Drain WATER SYSTEM Hopper Size ^ S Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee d Area Drain blain Drain Fee p Water Leader Stom Drain Fee Sprinkler Valve Water Sys.Fee Relief Valve Gas Fee Vac Breaker Skimmer Filter Permit Fee QQ Total /p /{,�yj Total Fee r B