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AIPPLLCAr �IOgFQR PLUMBING PERMIT
9 CITY OF CUPERTINO
I 1UL 12 1968 p- Sanitary No.
Date < , 1961L Permit No
r -7:r 1^ �'�^} a Fee S 29•-+1'O
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other/haws applicable thereto.
Use of Premises
owner—(—
By
wner(—By cE�• •t�L f�JL_ c
CONTRACTOR. AGENT
-
Phone 0'J -Z'
State License 7�'`3 %
Address
Address
WILLIAM D. BENEVICH
Approved
PLUMBING INSPECTOR ✓
FIXTURES
NUMBER IIWf
MAIN DRAIN
UNITS
.FEES
UNITS. FEES
Water fleeter
A J-�
Size
Water Closet
.3
Z/ YZ
Material C. `
Bath Tub
fl
To Curb
Shower
°P
To Prop. Line
Lavatories
�`e
To Existing
Kitchen Sink
fV
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
WashingMachine
/-5-0
Size
Water Softener
Material
/
Bar Sink
To Main Drain
Comb.Sink & TrayTo
Cur
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material rryZ-
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
.fes
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
—
rinklerValve
Wnter Sys. Fee
/.3,0
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
=Towf-z'
Total
.-