NO PERMIT NUMBER (3) IDI T I I� I EV ITL �� 1 LOT NO. 32--
NO. STRF.F.I'
N APPLICATION FOR PLUMBING PERMIT
Wi
OITYs OF CUPERTINO
a o AUG Sanitary No.
3 a Uate 19652 Permit No
wu V FeeS �s' yy
' 0 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
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all othheeerr�laws applicable thereto.
wS /� � s
J
Use of Premises
O 0 O
oa Owner l t 1 s _ A Lj Address
B C � ?,cD•, 9.u.
O y CONTRACTOR, AGENT Charle$ 5tree
3 < Phone.l9 �� OSS 6e San Jose, California 95112
w WILLIAM D. BENEVICH
a o State License 7�5 3� Approved
�\ —U PLUMBING INSPECTOR
FIXTURES NUMBER W 6 MAIN DRAIN
13IT5 FEES UNITS FEES
Water Beater /• Size a " J-U
Water Closet "y .�-O Material
Bath 'Cub /. To Curb
Shower . JT To Prop. Line
Lavatories 41.4 D To Existing
Kitchen Sink / 4-3' 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 Material .L . TO
Sand Trap TOTAL FEES
Urinal Fixture Fee Ar
Area Drain Main Drain Fee o—o
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /,J'
Relief Valve Cas Fee /, J
Vac Breaker
Skimmer
Filter
Permit Fee "2,00
Total 0 Total Fee T o—d