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L LOT NO.ST
NO. STREEI'
PPIC ATjIN FOR PLUMBING
CUPF,RTINO
tlWWI Sanitary iA'I
PERMIT
2 n 1966 5-114Date q �* Permit No
196
rtTY 106 CUP RTI1y� Fee $ 9, .1�
A pplicatio ns r y- � r � of Cupertino for permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
Address,3 3% '/ 7Lr A -L
WILLIAM D. BENEVICH
State License .\!3 3 > Approved
PLUMBING INSPECTOR `/
FIXTURES NUMBER MAIN DRAIN
UNITS I FILES UNITS I FFES
Water
To
Kitchen Sink
Dish Washer
Machine
Comb.Sink&Tray I 1 11 To Curb
Floor D ain WATER SYSTEM
Fu—pp,— Size
YC$"..Im
Area Drain I 1 11 Main Drain Fee
Water Leader I IStorm D ain Fee
Sprinkler Valve I 1 11 Water Sys. Fee
Relief Valve
Vac Breaker
Permit Fee
Total Fee