LOT 44 LOT NO.
NO.
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FOR PLUMBING PERMIT
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:I�'Y Of CUPF.RTINO
r o Nov 1 1967 Sanitary No.
Q LL
o Date 19C7Z Permit No
3
Csv1 OF CUPERTINO Pee 5c) 3. sZ
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' 0 Application is hereby made to the City of Cupertino for a permit to install Plumbing
o a 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
a w Cupertino, and all other tws applicable thereto.
0 o Use of Premises tin5!10
> N
3 Owner ✓ �� Address
_ X50 y�
z By Add-,/450
O CONTR CTOR, AGENT
a Phone
- N
rc a WILLIAM D. BSNEVICH
oo State License l/s�9 Approvedd
( I -U "� PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Waterlleater Size
Water Closet Material
Bath Tub To Curb
Shower / To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
—
Washing Machine J 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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee / o
Area Drain Main Drain Fee S=�
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee Z
Vac Breaker
Skimmer
Filter
Permit Fee C9—
Total 3 Total Fee �3�D