NO PERMIT NUMBER (5) Gi
�O�O /// G 1"9-4e& OT NO. <z- J
e`APPOcATIOWFOR PLUMBING PERMIT
" d CITY OF CUPERTINO
z
43 i o ! AUG T 2 �C6$ Sanitary No.
Y
Q LL
0 a Date _ G^ 1964 Permit No
w n Fee $ .78•eo
10
Application is hereby made to the City of Cupertino for a permit to install plumbing
'o 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
i w Cupertino, and all other laws applicable thereto.
Use of Premises
00
> 0 /-e ✓O S? r�
3 OwnerAddress
B �Gjy/TCS Address v YJ
J o y CONTRACTOR, AGENT
3 k: 7�F — OJ 7-S
— `
Phone
—
z WILLIAM D. BENEVICii
w z
rc a � 7� J�3 7
< o State License
App
rov/ed
-U N PLUMBING INSPECTOR
FIXTURES NUMBER ILVO MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater ISize
Water Closet TJ Material( , 7--
Bath
Bath Tub ro To Curb
Shower ,JZ To
Prop. Line
Lavatories t1 (�a" To Existin
Kitchen ink / !-D Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size //'
Restaurant Sink I Material L 1 0-0
Sand Trap 'TOTAL FEES
Urinal Fixture Fee Idp, `-0
Area Drain - Main Drain Fee
Water Leader Storm Thain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee v
Vac Breaker
Skimmer
Filter
Permit Fee
TotalV 4`� Total Fee ��