No Permit Number (3) 0/ 35 ly L A) �� LOT NO, 5"z O
NO. -STREET
�, APPLICATII NtFOR PLUMBING PERMIT
z a CITY OF CUPERTWO
xo r�Ur, 1u ossa Sanitary No.
Q 4 fj
o < Date I+ 196& Permit No
3� r.,.. r �� .��n.` Fee$ a`l. a�
o Application is hereby made to the City of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
i 1- 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 �Q S
00 ,�}}.
3 Owner�L Address
oBy CP,ItRQI�, ,�n., 9.u.
F Q CONTRACTOR,AGENT 625 hai(eS SFre
w Z Phone/ 8-OSJ� San Jose, California 95112
w wWILLIAM D. BENEVICH
a o State License ,7/�3 Z- Approved
-0 PLUMBING INSPECTOR /
FIXTURES NUMBER P MAIN DRAIN _
UNITS FEES UNITS FEES
Water Heater Size <66
Water Closet Material [f. Z
Bath Tub / r: To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen inkJ,0 Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener !11
Bar Sink To Main Dra n
Comb.Sink&TrayTo Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Isize
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee / S D
Area Drain Main Drain Fee 9- 00
Water Leader Stora Drain Fee
Sprinkler Valve Water Sys.Fee <0
Relief Valve Gas Fee
Iso-
Vac Breaker
Skimmer
Filter
Permit Fee :L DO
Total / Total Fee 2 5�