51192/o/ 8D I � LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
¢4 ,i} Sanitary No.
o a Date 1 196 Permit No �� Z
w MAR 12 1968 Fee s o2-sem
I LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes audyV fixtures hhistedjnjyJtc•.reNerse side hereof, and agrees to install said prices
I and/or. Utures�in accoMancc. with.the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
~ Use of Premises00
�t.s.
J 4
3 Owner" -r4 S Address
se"ka CIO zAddress a90— OSS"L
o By cw�
C0bZbAV90Aea
Fair
3 Phone Can Jose, California 95112
w z WILLIAM D. BENEVICH
ww
rc a 'f Approved
37
o State License 17/
U PLUMBING INSPECTOR
X
d' YfKTURES I NUMB11 MAIN DRAIN
UNITS FEREES UNITS I FEES
Shower
Q To Pro .Line
Lavatories 'I'o Exi stin
Kitchen ink pNot Conn.
Dish Washer Sewer Box
Waste Disposal
Size
Water
10,74101
Con".Sink & Tray To Curb I I
Dental Unit
Floor Drain WA rER SYSTEM
Hopper Size I" I
Valve
Filter
Main Drain Fee
Storm Drain Fee
Total Fee