51179LOT NO. %`i
NO. STREEI'
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.APPLICATION FOR PLUMBING PERMIT
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OF CUPERTINO
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rq, Sanitary No.
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0' Da A 1qA7 1961 7 Permit No -sly
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W, Fee bc?
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� yl.4o rs hr(p (Q, City of Cupertino for a permit to install plumbing
o a pip�n8/oNflxtuMs+ fstillhreverse 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
a w Cupertino, and all other I ws applicable thereto.
Use of Pre......
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0 3 Owner
U�911� / � Address
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z By_T/L� /- ctt/�f�fzYi/G/l Address
n CONTRACTOR, AGENT
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�.OfiS%� ILLIAM D. BENEVICH
State License Approved
�`J— U PLUMBING INSPECTOR
FIXTURES I NUMBER �� MAIN DRAIN
ONITS PEES TIN ITS I FERS
Rater Closet I --Z' 1 11 Material �-/,
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Shower i / 1 11 To Pran. Line I ,
Kitchen ink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Comb.Sink&'fray I 1 11 To Curb
Drain
Valve
Filter
Total
Size
F Ixcure r ee
Main Drain Fee
Storm Drain Fee