NO PERMIT NUMBER 1621 LOT NO. .
NO. STREEI'
z �
APPLICATION`�'F0R PLUMBING PERMIT
CITY OF CUPF.RTINO
s.mitarp No.
� LL Q
0 Date 6 196 O Permit No
Wk 3 ` _
_U /l Fee $o '6 0
Q
� 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
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
Use of Premises
00
� 3 Owner L � I_., r/1/ .5�+ Address
By. C ee
O CONTRACTOR, AGENT �25 CharleR ree
— < Phonra lp f—O ,L 5Can lose, California 95112
w w WILLIAM D. BENEVICH
ao state License/ 7/6-21:2Approved
_U •� PLUMBING INSPECTOR
FIXTURES NUMBER tL)6 MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater JV Size 41 .769-0
Water Closet y B-d Material C/
Bath Tub / J-0 To Curb
Shower / /. J-ZI To Prop. Line
Lavatories '5 44.JO To Existing
Kitchen Sink •/-J Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
WashingMachine / /. Size
Water Softener Material �-
Bar Sink To Main Thain '
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /'
Restaurant Sink Material CrgL 1 11-ra
Sand Trap TOTAL FEES
Urinal Fixture Fee J-0 0
Area Drain Main Drain Fee
Water Leader Stolm Drain Fee
Sprinkler Valve Water Sys.Fee /. J-0
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �.• �"�
Total /p Total Fee a 0