NO PERMIT NUMBER�a 33 r1 X//Y JCC XIP LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
in d CITY OF CUPERTINO
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F ii�7�-`� Sanitary No.
0 a Date� I pip,
6 Permit Nn/U '�15tN 9 67-' Fee$ Z6.J
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47
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Application is hereby made to the City of Cupertino for a permit to install plumbing
0 . a adnfinr�lttehereof, td prices
norfiztur YJOheproviionsof he Plumbing Code of the
< w Cupertino, and all other laws applicable thereto.
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W Use of Premises
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� 3 Owni^i�-����l.��-' Q�� Address
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, By Address �
O CONTRACTOR,AGENT 17
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-m Phone 117, -IF r�77
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0 R WILLIAM D. I3ENEVICH
0 s State License y3 9 R Approved
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U PLUMBING/INSPECTOR
FIXTURES
NUMBER
F MAIN DRAIN
UNITS FEES
UNITS
FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Waste DisposaIJ
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
OP
Area Drain
Main Drain Fee
00
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Svs. Fee I I_ .
rD
Permit Fe
Total Fee