51009 [074 LeeIQ G7— LOT NO,
NO 0 TRP,
PrJUL
IOR PLUMBING PERMIT
zaC OP CUPERTINO
2 9 1965 Sanitary No.
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0 , Date 196— Permit No -3 �D0!7
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W CITY OF CUPERTINO Fees SC d=
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' o Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
o apipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I 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.
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a Use of Premises
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3 Owner S „ (,,,, ,t AddressJ-?g/
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J z By J�e << + A r- J, Address
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3 F per, AGENT
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w WILLIAM D. BENEVIGH
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0 a State License Approved
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_V PLUMBING INSPECTOR
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FIXTURES NUMBER
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink m Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee o2�
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
-Prinklcr Valves Water Sys. Fee
Permit Fee p O-V
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Plain Drain
Final