2119-PLUMBING PERMITIV I 1 -L I :LCA V- (3 o LOT NO.
NO. STREET
AR PLUMBING PERMIT
z a D T CUPF.RTINO
Wz
0 Sanitar No.
0° l Y 2 3 1963 y
0 a Date 196 Permit No. 7
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nn[[ (��'� I�Dp��pp �R�n Fee $
O Appli&4TnYis 1Q eby eh RV City of Cupertino for a permit to install plumbing
LL 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.
J LL Use of Premises for --S
00 30c��) F�LS�r7r= U
oa Owner Address_ «y qz t- I � c-,-4'" c ,
J o B Address�.(L,
3 N P ne
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U aWILLIAM Cl. BENEVICH
a
0 tate License 444 Approved
UNITS FEES
Water Heater
Water Closets
Bath Tubs
Showers
Lavatories
Kit6Ien Sinks
Dish Washers
Waste Disposals
Wash Trays
Washing Machines
UNITS FEES
Size
Material
To Curb
To Prop. Line
To Existing
Not Conn.
Sewer Boxes
STORM DRAINAGE
Size I I
.Nater 5otteners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
►door Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
Area Drains
Main Drain Fee
)Vater Leaders
Storm Drain Fee
Sprinkler vaives
Water Sys. Fee
Permit Fee
RECORD OF INSPECTION
Underground Rough ..
.Partial Rough..
Rough. Complete..
'\•'Iain Drain
Final... , �-