NO PERMIT NUMBER (5) 19e-EA) / L LOT NO. y
N 4. ;7'N7 ..�,- Ei
APPLICATION FOR PLUMBING PERMIT
N
CITY OF CUPF:RTINO
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f iei Rola 12 1968 Sanitary No.
0
O ' Date 196& Permit No
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w n 1 Pee $
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� 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
,� Use of Premises a 5
00 r I T
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3 Owner.� 1. 1 A) <A T Address
By Cif "X`d�` s
3 O CONTRACTOR, AGENT 625 Charles rsee
— < Phone 8- OSJ� Can Jose, California 95112
w WILLIAM D. BENEVICH
a o f
State License / 7 JS -37 Approved
��-U PLUMBING INSPECTOR V
FIXTURES NUMBER Lj P MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater "SD Size // �Od
Water Closet Material
Bath Tub / c l) To Curb
Shower ,�� To Prop. Line
Lavatories AAo To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Mareri
Bar Sink 'I'o blain Drain \
Comb.Sink R Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain I WATER SYSTEM
Hopper Size / "'
Restaurant Sink Material 6e4 ,Q}.
Sand Trap I`OTAL FEES
Urinal Fixture Fee Iq SO
Area Drain Main Drain Fee 5- 00
Water Leader Storm Drain Fee I
Sprinkler Valve Water Sys.Fee <'O
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee DO
Total / 'Total Fee a9 Sa