2196 yfl�
��"�'u�F LOT No.
C� PPLICA f OR PLUMBING PERMIT
wz ' IJUN 20 196 IT'S OF CUPF.RTINO
x o Sanitary No. _
3 Date ` — 6- Permit No
LL lo:a i lrUi'C i' Y + Fee$ 37 C)
o 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 laws applicable thereto. _
w x
a
0 a Use of Premises
00 n � ^ ,�
3 Owner `�&IzzC WL 1. - 'Address�m���� }
<n/ ,•
i J /A�� {-lam/�/f .a�
By o CTOA,Ac•Nr �— Address - QC�I
3 Phone
aw w - WILLIAM' D. BENEVICM
2 tate Limns /Z yaks' Approved A
UNITS FEIiS jF' UNITS FEES-
Water Heater A 00 Size t' DO
Water Closc[s .00Matcral
Rath Tubs 0 V To Curb
Sh<Avers .p To Prop. Line
Lavatories To Existing
Kite en Sinks ) Not Conn,
DisWashers 1 .0'0 Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines 1 •O U Size
Water S— oTteners Material
Bar Sinks To Main Drain
Comb. Sink s rays To Curb
Denial Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers Size j
Restaurant Sinks Material A/
Sand Traps TOTAL FEES
renals Fixture Fee Q db
Area Dr:uns Main Drain Fee pQ
UUater. Leaders Storm Drain Fce
Sprinkler Naives Water Sys. Fee !
Permit Fee _ .60
TO AL Q TOTAL PEEfiro0
RECOR OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
'in
Drain
Final...
t�
�M.
•n. t
Bldg. Dept
- Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
Sewer �oenection Sanitary Permit No. o .....
[✓Plumbing Final Plumbing Permit No. .p"C�f�.(�.........
. Lot No. ...�j.�K^r`
r
Owner o_rr
Tenant ...... .. . . ... . .. .. ........ ..
At D IO ... . ..... ... ...................................... .
. ..
�I/�a , :.
Tract ............... F ... ... .......................................................... .........
DateConnected ..............................G-.- "gr.......................................
Date Final ..-. ... .�... d. 19
.................. .......... .... ..;.f..... ,._,...-..........-'---
.......... ................................
PLUMBING INSPECTOR
III 7/63-1M
I , alt.. .' - i