NO PERMIT NUMBER LOT NO.,z/J
NO. STREF.I' 77��
/SPP AC�kyT ON FOR PLUMBING PERMIT
w CI TOP CUPk:RTINO
2 ij�r ° Y e Sanitary No.
14 1961
0 a Date .96� Permit No
3
w LL Fee $
° Ap7icat�on 0,)rhererby?m1Efj1TWGity of Cupertino for a permit to install plumbing
o pipes
and/ fixtures fisted on he reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the pro�'isions of the Plumbing Code of the City of
a w Cupertino, and all other I ws applicable thereto.
w x
� r
Use of Premises
00
> N / !lam
Address
o J
z By Address
° CONTRACTOR,AgENT
— < Phone
w WILLIAM D. BENEVICH
Approved
o
State License,
I�-U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UN[TS FEES UNITS PEES
Water heater / Size _
Water Closet al
Bath Tub / To Curb
Shower / To Prop. Line d
Lavatories To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink kWATER
ain Drain
Comb.Sink R Tray urb
Dental Unit
DrinkingFountain
Floor Drain SYSTEM
Hopper Restaurant Sink rial
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee Hyl
Total S" Total Fee