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LOT NO.
NO. ETRE
A1O �FIOR PLUMBING PERMIT
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3 U Date (r+�'T�/ nC CUPERTMU 196 Permit No o'a
W LL SPf r S hr Pee $
To
� Appl t o is ereby male to the City of Cupertino for a permit to install plumbing
o a 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
a W Cupertino, and all other laws applicable thereto.
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Use of Premises
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O i Owne7 �I�/I7• ���I (I/� !SS Armr ON
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W w WILLIAM D. BENEVICH
ao State License Approved
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0 PLUMBING INSPECTOR
FIXTURES NUMBER jj MAIN DRAIN
UNITS FEES 11 UNITS FEES
Water Heater 11 Size
Water Closet A Material
Bath Tub f To Curb
Shower .t To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGI
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain I WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee dL
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 tJ
Total Total Fee
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d,QQN FOR BUILDING PERMIT
CITY jtUPERTINO
Sanitary No.
Date V( I 19 Permit No. ,rz// 601,
A l caCion is hreb • . it to -
a 2 5T/ C%' /
a 9- 4 story, Type `02 r3 ( �� ��" ' Building
to be occupied only as R�0_ S , in /accordance with
Plans, Specifications and Plot -Plan filed herewith. PI Ck Fee f V •��
Estimated Value of Improvements, $/di 606 I. Fee $ �3 • a
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
C Ownerr S N�beir-
_ /. Address
BY Address
Phone G ` (; 3/� Approved /
WIL.LwIAM D. Y3E !EVICI�
State License BUILDING INSPECTOR ,/
JOA`( 20
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