51179 PLUMBINGNO
NO. STREET
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APPLICATION FAR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
Date" 3 — 196' ermit No. -4—'&7
Application is hereby made for a permit to
a/_ s ory, p % / uilding
to be occupied only i c" t�e with
Plans, Specifications and Plot -Plan filedl /hherre-wi®.o P1 Ck Fe
Estimated Value of Improvements, $ J—�® c Fee $ 1W
it is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupert, I be com lie with. nn
Owner 2 p2—lr�s�� �' Address /6 D 'IS POAZ7%:
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By �f
Phone r-� S 7—
State Licen
Fur. Mr. _
W.W.WF®RN-a-!WS --
LOT NO.
NO. STREET
��P ON FOR PLUMBING PERMIT
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z iCUPERTINO
xSanitary No.
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° a Da (N�/� 67 196 ' Permit No
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LL UT'Y1 j@� il�Yl-YLI'lpNo PCC
' ° �1 lic t i tI the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures liste on the reverse side hereof, and agrees to install said prices
r . and/or fixtures in accordance with the provisions of the Plumbing Code of the City of-
<w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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0 3 Owne Address
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° Y� /.d�iyJi_ L� Address
3 _ CONTRACTOR, AGENT
— < Phone
w w WILLIAM D. BENEVICH
aa State License i�JT� Approved
-U IY 4, PLUMBING INSPECTOR r/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNIT FEES
Water heater Size
Water Closet Material
Bath Tub To Curb
Shower / To Prop. Line v
Lavatories To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
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
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee 07
Vac Breaker
Skimmer
Fi Iter
Permit Fee
Total Total Fee