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NO. STREET
AP.PLICAtTI16WFOR PLUMBING PERMIT
CITY 6L, CUPERTINO
f D C f 19S7 Sanitary No
Date 1967 Permit No SioO/,�j
f OTl^I 1 Fee$ "?q,
J
Application Whereby Gty of Cupertino for a permit to install Plumbing
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
Cupertino, and all other laws applicable thereto.
Use of P emises Q /4, OZIA-e.oe
Ow//e��r ti �0Q� Address, K- -z-�r
By(9r'r .C.Liy..czlC /�. Address
CONTRACTOR, AGENT tl.
Phone a9.3 -,H0 77
State License -2 -9 1-s 3 .r Approved WILLIAM D. BENEVICH
PLUMBING INSPECTOR /
X
FIXTURES
NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water Heater
I Isize,
Water Closet
1 Material
Bath Tub
I To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer T
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
-
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
. SD
Area Drain
Main Drain Fee
OJ
Water Leader -
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
j p
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
0 a
Total
Total Fee