NO PERMIT NUMBERa U
A
1 6 1 Sl 1 73 i L_ k: H Pr_ 19C.E LOT Nn.
NO. Sn EE.I'
APPLICAtTIOWFOR PLUMBING PERMIT
'CITY OF CUPERTINO
�( I AM 1 )/1968 C Sanitary No.
Date— 196j?Permit No
h' 'V -"Ir),. Fee $ Jy
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 laws applicable thereto.
Use of Premises RhS
Owner. h n Address
y CONTRACTOR,AGENT
B '�+ Charles
r
Phonee�J DSS can lose, California 95112
State License f ) J 16312
WILLIAM D. BENEVICt
Approved /
3( PLUMBING INSPECTOR , /
FIXTURES
NUMBER
j% MAIN DRAIN
UNITS1
FEES
UNITS FEES
Water Heater1
/r -O IlSize
o0
Water Closet
Material C
Bath Tub
/
/ J'p I
To Curb
Shower
/ J-0
To Prop. Line
Lavatories
4
,0-0
To Existing
Kitchen Sink
, TV
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash TraySTORM
DRAINAGE
Washing Machine
/
/,%.�
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.SinkBTray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYS'CEM
Hopper
Size /
Restaurant Sink
Material G�-L✓ ,TD
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee i u -D
Relief Valve
Gas Fee /i J—b
Filter
Total Fee