NO PERMIT NUMBER/0/3 21 V/ L /'c H �:� t LOT NO. J
NO. STBF.F,I'
APPLICATIONFOR PLUMBING PERMIT
'CITY OF CUPERTINO
AUIa O'� Ig6$ .. �% Sanitary No.
Date 0 , 1961L Permit No
Application is hereby made to the City 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.
Use of Premises ZES .
1
Owner I , Address_
By
AGENT 625
State License
California 95112
WILLIAM D. BENEVICP
Approved
PLUMBING INSPECTOR
FIXTURES I NUMBER G MAIN DRAIN
UNITS FEES 11 UNITS FEES
Water Heater J-2� I Size 4oa
Water Closet o2 OrJ I Material %
Bath Tub /. w I To Curb
Shower /
/.I/%1
To Prop. Line
Lavatories 7
C/ Jit
To Existing
Kitchen Sink /
/. JZJ
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washin Machine
,J -D
Size
Water Softener
Material
Bar Sink
To Main Dra'
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
I Material/'I
j/. To—
Sand Trap
TOTAL FEES
Urinal
Fixture Fee /f ado
Area Drain
Main Drain Fee ,r0 -r1
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
ermit Fee
Total /O /,r.ft PTotal Fee yd' e -o J