51167.1C IZa?,5 I C_�� LOT NO^
NO. STREET
N aAPPLICATION11FOR PLUMBING PERMIT
i CITY OF CUPERTINO
Y o sr it =7 �, Sanitary No.
o a Date ~L�O 196, -Permit
3U
No S// / 7, /
1,' Pee S o2 S )
PITY
App`I ¢tin is hereby' male to therCity 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.
State License
W
Approvey;LL1AM D. BENEVICH
PLUMBING INSPECTOR k/
FIXTURES
I NUMBER
MAIN DRAIN
UNITSI FEES
11 UNITS PEES
Water Heater
Size
Water Closet
Material G�
Bath Tub
To Curb
Shower
To Prop. Line ✓
Lavatories
�3
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Bar Sink To Main Drain
Comb.Sink &fray To Curb
Dental Unit I 1 11 1 j'
WATER
rxture
Area
Water Leader Storm Drain Fee
S rinkler Valve Water Sys. Fee /To
Relief Valve Gas Fee
Vac Breaker
1 11 Permit Fee C;e
Total // GTd- 11 Total Fee SD