NO PERMIT NUMBERLOT NO. 1 /
NO. STREET
A_ P_PLIC'ATIOWFOR PLUMBING PERMIT
CITY OF CUPERTINO
l� 4 AUG �� � 68 r sanitary No.
Date 196-Y Permit No
�.._..Nr '%— ^ N 'ori Pee $ .6 0
Application is hereby made to the City 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 otl applicable thereto.
Use of Premises
State License % 7)-5-27
JW.
California 94ILLIAM D. BENEVICH
011 PLUMBING INSPECTOR v/
FIXTURESNUMBER ES MAIN DRAIN
UNITS FEUNITS I FEES
Water Closet
To
Kitchen Sink
, J-0
k Not Conn.
Dish Washer
k Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
, f0
Size
Water Softener
Material
Bar Sink
To Main Dr '
Comb.Sink & Tray
To ur
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size / ./
Restaurant Sink
Material irAL I
Sand Trap
'TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
. JT[
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total /D
f
Total Fee
o -o