2199 NOS
LOT NO. /
APPLICATION FOR PLUMBING PERMIT
W JUN 20 1961 { O CUPERTINO
Y o _ _ Sanitary Nu.
0 j Date1 uFr 1,��9t6��3 Permit No
xa Fee$
Application is hereby made to the City of Cupertino for a permit to install plumbing
O` pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and all of r laws applicable thereto.
W Use of Premises c/✓OC!!JJ
00
oa Owner ��pG. ,�f/ Address
z J �"
z By icl/lLv1 1�f-il.irn, to Address
O Cdlt17RACIOR,AGENT `+
— W Phone _
WILLIAM D. BENEVICH s
a o State License G 36 ' /2 r/3PS -Approved
_U w LIMB G uvaYLCl OR
r • a
UNITS FEES UNITS FIi ES
Water Heater I .OU Size y° At.0
ater Closets 3 100 Material G
ath Tubs 1 10 d "Co Curb ld _
Showers . 0 O "Co Prop. Linei ;.
Lavatories x,00 To ExisCing a j
itc en Sinks I Not Conn. Y, *�w
pis Washers I 1 .O U Sewer Boxes
Waste Disposals 1 „na
tUas Trays STORM L)RAI GES.
\'a5 ling Machines L .O Size y tt9F.:,3��'•.'
sU ter Softeners Material
Bar inks To Main Drain �{ w
Com . Sin SNTrays To Curb '
'—
De1ua1 Uriit3 _�'�
:(5rinking Fountains
"ioor Drains ''r WATER SYSTEM
vPpero a' Size
Restaurant Sinks Material
an raps TOTAL F,I'
1 rinals ' Fixture Fee ;'•jS7 _
Areal Main rain Fee.'r; >Q
Water Leaders Storm Drain Fee ti• St
Sprinkler Varves Water Sys. Fee . '((�
Permit Fee
TOTAL, 400 TarAL FEE j(atx
RECORD OF41NSPECTION
Underground Rough... . '
.Partial Rough.. 6-,a/J''.
''.Rough. Complete..
3
\Iain Drain
Final... • ._� .' � "
Bldg. Dept.
Office Copy
BUILDINd-INSPEC 'S OFFICE
CITY OF CUP /INO
Sewer Connection Sanitary Permit No. .......3.3t)-1
...............
li;4lumbing Final Plum ng P q 9
urilln L-40. ..........
Lot No. ......
Owner or Tenant .............a"
.......... . ............z...........................r: - ----- --------
At ---------------l...0.2...- � ........ . .... .. ......
Tract ------ ................. ...... _44,41-4:4-
----------- - --
11
Date Connected ............................... .......1�.................... I..... ..................... 19Z...
L,
Date Final ............................................ . .
.. ...........
. .................... 1 ........../
.......... ..... .... .......................... ........ ...
',PLUMBING- rNsp cr6
4�7/4299w-