NO PERMIT NUMBER/O/ r� / I Z I L f C- iN - L, jij<— LOT NO. esLX-
NO. STREET �
`
APPLICATIONFOR PLUMBING PERMIT
z d � E 'CITY OF CUPERTINO
i
r O I I AUG T 1968 C Sanitary No.
o < Date 6 1961 Permit No
i o
� 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/r laws applicable thereto.
w !mac S
r r
0 a Use of Premises
00
3 Owners__!/_L. x I!s� Address
o a ��`���� J'
z By (ivnfAa( esex..9it�.
O q CONTRACTOR, AGENT 625 Charles Street
3 `m Phone r�-! iT� O .S G WILLIAM D. BENEVI
W � San dose, California 95112
(`(I a o State License % 3% Approved
l — U X PLUMBING INSPECTOR • /
FIXTURES I NUMBER 10 D MAIN DRAIN
UNITS I FEES 11 UNITS FEES
Shower
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Size
Water Softener
Comb.Sink &
ountain
Nloor Drain
11 WATER SYSTEM
Rapper
Size��
Restaurant Sink
11aterial ; 4, ,9
Sand Trap
TOTAL FEES
Urinal
Fixture Fee I / Q(j
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Valve
Filter
Permit Fee a D O I
Total / /f!, jJ 1 Total Fee x$00 J