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M-1 70 I &A rL/ LOT No. /Z
NO. STIUi El'
APP_LICATJ N FOR PLUMBING PERMIT
7,,a J -OF CUPERTINO
Date I N 3/'1968 111,916E
Sanitary No.
Permit No -6 i1�; Z -
Fee S c Z 3, a--6
ApglcCftir,h islITre4? ijtlIlklirtjthelCity of Cupertino for a permit to install plumbing
pipes and/ot fixtures listed on theireverse 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 Premises T' 1E 5
Owner_j_jt4 � I4_YgS5 Address
Byr�A/-•-R.NL 6E.2d Address 62S644S Sy
CONTRACTOR, AGENT
Phone X91-- O Sts
/ �SWILLIAM D. DENEVICH
State License. Approved
PLUMBING INS 7CfOR
00 FIXTURES NUMBER II MAIN DRAIN
UNITS FEES UNITS I FEES
Shower I I I /15Z) 11 To ProD. Line J I I
Dish Washer H Sewer Box
Waste Disposal
Wash Tray�i STORM DRAINAGE
Washing Machine / /„� Size
Comb.Sink&Tray I 1 11 To Curb
Floor Drain
ze
Area Drain Main Drain Fee —60
WaterLeader Storm Thain Fee
Sprinkler Valve Water Sys. Fee 1
Relief Valve I 1 11 Gas Fee I i n�
Total I "I I 13 011 Total Fee I 1 Q 5!2-1