51167.1- -'I�v LOT NO.
NO. STItEE.I'
APPLICATION FOR PLUMBING PERMIT
MY OF CUPERTINO
',��
I i Sanitary No.
Dite�� ,'I;;�-51 1967 it ;'1962 Permit No �i�/�4,7, /
Pee $ o2 6`0b
Applicntionlish, ly[p�adep[thgCity of Cupertino for a permit to install plumbing
pipes'andi/or�fizturc�stlis'tXdlln ih' Veverse 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.
1
Phone --5
State License ..,/-�ApprovedWILLMM D. 13ENEVICH
PLUMBING INSPECTOR I/
FIXTURES
NUMBER
MAIN DRAIN
Hopper
UNITS FEF,S
UNITS FEES
Water Heater
Material
Size
Water Closet
TOTAL FEES
Material C%/
Bath Tub
Fixture Fee /
To Curb
Shower
/
To Prop. Line
Lavatories
Storm Drain Fee
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Gas Fee
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Comb.Sink&Trav I 1 11 To Curb I 1 1
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee /
_Q
Area Drain
Main Drain Fee
•ZI
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee��
Total
i,_ Total Fee
X57