NO PERMIT NUMBER LOT NO. c3
NO. STREET
A PP LIGATION FOR PLUMBING PERMIT
�l('ITY�OF CUPERTINO
z ,
r o 1 i AU— ? 1968 sanitary No.
LL
0 a Date G 196F Permit No
>U
P �r �' Pee S
O 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
a w Cupertino, and all other{r laws applicable thereto.
LL Use of Premises
20
3 Owner L t 1 v n Address_
z By
[�
3
o CONTRACTOR, AGENT Charles tree
— 0 Phone a-9 8' OS'J G San Jose, California 95112
w w WILLIAM D. BENEVICH
F State License 7153 Approved
�— a o
- X
U PLUMBING INSPECTOR
FIXTURES NUMBER AJD MAIN DRAIN
ONITS FEES UNITS FEES
Water Heater /. J D Size '41 "
v o
Water Closet 9 L/'. J u Material C T
Bath Tub / /. rD To Curb
Shower / /. JD To Prop. Line
Lavatories /,Bo To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine / /.JD Size
Water Softener Material
Bar Sink To Main Draio"
Comb.Sink&TrayTo Cur
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /
Restaurant Sink Material Gq(v I / J"d
Sand Trap TOTAL FEES
Urinal Fixture Fee /f.61-
Area
f.61-
Area Drain Main Drain Fee ,r. 8+'
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee J?>
Relief Valve Gas Fee /.,/,2)
Vac Breaker
Skimmer
Filter
Permit Fee 2
Total /Y /f- Total Fee ;-,f