No Permit Number (4) 1017 -1 I //7���2�� Ag:�' LOT NO. T
NO. rmSTREET
,„ AIPPLLCArtidgfQOF R PLUMBING PERMIT
z < HTY CUPERTINO
' 0 9t�U ] 12 1968 Sanitary No.
p LL p
o a Date 1961L Permit No
3 u ("7tr •�•-
m r - -^� '� Fee$ 29,ry
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 prices
> < and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all other/haws applicable thereto.
a Use of Premises
00
O 3 Owner
Address
O <
ZJ
Z By �E�T�t�G CJZ- t D Address&' YS-- G��-a%r7 ,rT
O CONTRACTOR,AGENT-
W
- ma Phone
WILLIAM D. BENEVICH
u f State License 7�f3
a o Approved
-U PLUMBING INSPECTOR ✓
FIXTURES NUMBER IIWf MAIN DRAIN
UNITS .FEES UNITS. FEES
Water fleeter A J-� Size
Water Closet .3 Z/YZ Material C-`
Bath Tub fl To Curb
Shower °P To Prop. Line
Lavatories �`e To Existing
Kitchen Sink fV Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
WashingMachine /- 5-0 Size
Water Softener Material
Bar Sink To Main Drain /
Comb.Sink&TrayTo Cur
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material rryL
Sand Trap TOTAL FEES
Urinal Fixture Fee .fes
Area Drain Main Drain Fee
Water Leader Storm Drain Fee —
rinklerValve Wnter Sys.Fee /. 3,0
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
=Towf-z'
Total