2109 . Bldg. Dept
Pfii<e Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
0 Sewer Connection Sanitary Permit No. .... ........T........_...._
bing Final Plumbing Permit No.
4` Lot No. ....... ..... ..
Owner or Tenant r ..
I
Tract .................i_-
..... .......... .............
Date Connected .--------------------------------- --'L..... ...............Iwo- .
Date Final "' .?
✓r
PLUMBING INSPECrOR
r III 7/63-IM v�
i 3" I / /lA,�i�GG¢_C/ �� LOT NO. N >
NO. STREET -
FVAPPQ1C-ATION FOR PLUMBING PERMIT C.TY OE CUPERTINO
YoMAY 23 7963 ., sanitary No.
rc g o a Date '� - 1963 Permit No
CITY OF CUPERTIAT Fee $ �y a
' 0 Application is hereby made to the City 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
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
¢ w Cupertino, and all other ws applicable thereto. "
4 Use of Premises g
0 0
� 3 Own Address
ZJ
Z
By / Address I
3 F C CIOA,AGE
— � Pone • 3'�
T-ApprovedWILLIAM D. BENEVICH
FIXTURES NUIN PER MAIN DRAIN
ITo
UNI S FEES
Water HeaterSize
Water ClosetsMates;
Bath TubsTo Curb
ShowersTo Prop. Line .�
Lavatories Existing
Kitchen SinksNot Conn.
Dish WashersSewer Boxes
Waste DisposalsWash TraysSTORM DRAINAGE
\\'asking MachinSize
'rX'ater SoftenersMaterial
Bar SinksTo Main Drain
Comb. Sink s TraTo Curb
Dental UnitsDrinking FountaiFIbor DrainsWATER SYSTEM
HoppersSize
Restaurant Sinks Material
San Traps TOTAL ; :S
Urinals Fixture Fee .ao
Area Drains Main Drain Fee 'f-7p
Water Leaders Storm Drain Fee
Sprinkle, Valve+ Water Sys. Fee .00
Permit Fee o5 po
TOTAL TOTAL FEE p
RECORD OF INSPECTION
Underground Rough. -3
.Partial Rough.. — -
-Rough Complete..
Main Drain
Final_