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No Permit Number (4) 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�