51087 0 e
1® IA L��14TION FOR PLUMBING TPERMITS
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SEP 14 1965 U !' CITY OP CUPF.RTINO
x o Sanitary No.
LL .S`/ o k 7
304 at - 196 Pamir No
ITY' r Imo'°
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Application is hereby made to the City of Cupertino for a permit to install plumbing
a a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
I 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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w Use of Premises Residence
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3 OwnerFranklin-Bahl `'onst. Addres. P•O.Box 911, Campbell
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� o By_(,entral SerV� r•a Cn Tnr, AddresslF51 Queen- Tana S,J,
3 - CONTRACTOR, AGNT
— Phone 298-0556
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o State License 1?.���7 ApproWILLIAM D. BENEVICHved /
-U� PLUMBING INSPECTOR �/
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UNITS FEES UNITS FEES
Water Heate Q y Size
Wate; Closets Z Material G
Bath Tubs / p To Curb
Showers ou To Prop. Line
Lavatories a To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays 1 STORM DRAINAGE
Washing Machines ( 0p Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size /
Restaurant Sinks Material:=-, T-
Restaurant
San raps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee —
7-P71kler Valves Water Sys. Fee o
Permit Fee aft
TOTAL 7poi) TOTAL FEE p
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alain Drain
Final