51087 10721,— �yiGta T1riuP LOT NO. 27
I ION FOR PLUMBING PERMIT
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I-t CITY OF CUPERTINO
fWSEP ].4 1965
x o - Sanitary No.
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3 CITY OF
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O Application is hereby made 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 Residence _
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r3 Owner Pran1in_13ahl fn___n,_at AddressP QDQx ii Qar.npbell
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0 By Central SPryl rPCo- TnC.AddresS451 Oueens Lang, SnJ.
3 r CONTRACTOR, AGENT
— 0 Phone 298-0556
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aState LicenseApp,O,CWILLIAM D. BENEVICH
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U PLUMBING INSPECTOR
FIXTURES NUMB
UNITS FEES UNITS FEES
Water Heate od Sae 200
Water Closets 2 e Material 0-
4-bath Tubs f v a To Curb
Showers ( To Prop. Line
Lavatories To Existing
Kitchen Sinks ,. Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines to Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink % Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size I �` f
Restaurant Sinks Material �AL
San Traps TOTAL FEES
Urinals Fixture Fee p o
YArea Drains Main Drain Fee Oil
W ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee o U
^ Permit Fee o u
TOTAL p TOTAL FEE o
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .