NO PERMIT NUMBER (5) IoI6 _ /?JG ��i � / /'G LOT NO.
HaV A' sTR E 7 a y�
i
APPLICATION FOR PLUMBING PERMIT
W a t AUG 12 ;egg CITY OF CUPERTINO
i 1
z o Sanitary No
4 p
0 ' Date, - - C , ;962 Permit No
a
U ' Pee $ 18•^O
I LL
Application is hereby made to the City of Cupertino for a permit to install Plumbing
o a 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
a w Cupertino; and all other laws applicable thereto.
LL Use of Premises 12&
00 /� �
3 Owner.• "UD Sr9 y Address /
? zBy �C'�/ Q�G �n LO Address
J CONTRACTOR, AGENT
3 0 Phone�� � 6v- -6
wz
u Y State License/7/`,, 3 ApprovedrlLLIAM D. BENCVI::rI
1, < o
PLUMBING INSPECTOR
FIXTURES I NUMBER P].MAIN DRAIN
UNITS1 FEES 11 UNITS FEES
Water Heater / Size J:°a
Water Closet ,3 . 'Td Material i
Bath Tub To Curb
Shower / .J-0 To Prop. Line
Lavatories _6� To Existing
Kitchen Sink JO Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine r O Size
Water Softener Material
Bar Sink To Maimlhain
Comb.Sink&Tray To Curb
Dental Unit '
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material E,pL
Sand Trap TOTAL FEES
Urinal Fixture Fee ._
Area Thain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve I Water Sys.Pee . J-D
Relief Valve Gas Fee ,
Vac Breaker
Skimmer
Filter
Permit Fee
Total Y Ea Total Fee T7