No Permit Number (3) /o/G J I_._/! / t+ /�l��'-- M1/ f L LUT NO. L
APPLICATION FOR PLUMBING PERMIT
_ A11G 12 ia68 CITY OF CUPERTINO
rop Sanitary No.
0 a Date, - 2716 196 r1 Permit No
3 LL Fee$
0 Application is hereby made to the City of Cupertino for a permit M install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
z N and/or-fixtures in accordance with the provisions of the Plumbing Code of the City of
W = CupertiQ and all other lawns applicable thereto.
Use of Premises
00
3 Owner �• �'.vDSAY Address
oa
z, By Civ Q�G r Address
3 0 CONTRACTOR, AGENT
_ 0 Phone _P 1E — O ✓T�o
W
a a J'3 ) VdILLIAM D. BENEVICA
a o State License r Approve /
-U PLUMBING INSPECTOR /
FIXTURES NUMBER WD O.MAIN DRAIN
UNITS FEES UNITS IFES
Water Heater Size
Water Closet w. I-D Material i
Bath Tub To Curb
Shower J-3? To Prop. Line
Lavatories 6 .6--D To Existing
Kitchen ink � Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash TraySTORM DRAINAGE
WashingMachine _ Size
Water Softener Material
Bar Sink" To M ' ain
Comb.Sink&TrayTo Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /•
Restaurant Sink Material tS�
Sand Trap TOTAL FEES
Urinal Fixture Fee f-
Area Drain Main Drain Fee 1—.`O
Water Leader Storm Drain Fee
SpainklerValve Water Sys.Fee ,TO
Relief Valve Gas Fee
Vac Breeker
Skimmer•
Filter
PermitFee
Total Y Total Fee `�r7