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pec —L) LOT NO. x�
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
QTY OF CUPERTINO
Sanitary No.
Date ® DIF
Permit No �f/ / 'i S
�NOV 14 1967 Fee$`04 d
Application is hereby made to the City of Cupertino for a permit to install plumbing
pip s a .dirr fi>jtfyees (ys��0�ht �r grse side hereof, and agree to install said prices
and o es acc 1 , provisions of the Plumbing Code of the (:try of
Cupertino, and all other laws applicable thereto.
Use of Premises
By
CONTRACTORAGE T
,
Phone's ad -s' IJ6/
State
Address to Y �' "
Address—
WILLIAM D. BENEVICH
PLUMBING INSPECTOR
FIXTURES I NUMBER �� MAIN DRAIN
UNITS FEES UNITS I FF.FS
Shower
Kitchen Sink 11 Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Trav ST(1RM TIR ATNAf.F
Comb.Sink&Tray I 1 11 To Curb
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap.
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Valve
Vac
Permit Fee
Total Fee