NO PERMIT NUMBER1 - U
/c/b / I2l ItG N / L�� G LOT NO.
NO. � STREE.T- -
APPLICATION fFOR PLUMBING PERMIT
CITY OF CUPERTINO
/r�17�44 1 p
�'A1560 � Sanitary �u.
Date of 1962 Permit No
Pee$ S" 0
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. Q
Use of Premises /l F S
Owner—C , 4.1 Address
By eRnlla! SkW" j2- &C
CONTRACTOR, AGENT 625 Charles Street
Phone, San lase, California 9
W�LIAM D. BENEVICH
State License /7Approved
/ PLUMBING INSPECTOR , /
FIXTURES
NUMBER
WC MAIN DRAIN
UNITS
FEES
UNITS FEES
Water Ileater
/
Size 41, DO
Water Closet
�.-
3-Oo
Material e.
Bath Tub
/,,SD
To Curb
Shower
/
/.6O
To Prop. Line
Lavatories
�F,,SD
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
/-,�
Size
Water Softener
Material
Bar Sink
To Main Drai
Comb.Sink & Tray
To Cur
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material GHQ
/SO
Sand Trap
TOTAL FEES
Urinal
Fixture Fee / n
Area Drain
Main Drain Fee S'
Water Leader
Storm Drain Fee �-
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee -2-
Total
Total
/O
/$,00
Total Fee QQ