51179LOT NO.
NO. STREET
J'� OR PLUMBING PERMIT
z d ® — + SOF CUPERTINO
s° Y
R Sanitar No.
�IN 1G 1961
3° a Date 196-Z Permit No
U(n�C (� pp RR
LL QF 9N[1 I�t`Tk% Fee $
° Ap�ilicTatron £her } fi dy 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
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.
�. Use of Premises
0 0
3 Owner4 Address
zj
zB l Address
° CONTRACTOR,- , AGENT
- N
Phone
W Z
rILL1AM D. BENEVICK
a o State LicenseItL 7% Approve
- U PLUMBING INSPECTOR
FIXTURES NUMBER II MAIN DRAIN
UNITS I FEES UNITS I FEES
Shower /
To Prop. Line �—
Lavatories Z
To Existin
Kitchen Sink /
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Fixture Fee S-07
Wash Tray
STORM DRAINAGE
ig Machine
Softener
Comb.Sink&Trav I 1 11 To Curb
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee S-07
Area Drain
Main Drain FeeOV-
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /Sd
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ZQ�
Total
Total Fee