51046 /v I / 'x LOT NO.
NO. ST FET
APPLICATION FOR PLUMBING PERMIT
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IT OF CUPERTINO
xo Sanitary No.
o Datej' ,196_ Permit No -5 o 6
lyb/ �' ; Fee $,7 ov
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� A�l}$ication is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes`;ATIorOFixFure lr�t26'�3 i tY�e,reversc side hereof, and agrees to install said prices
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and/, fixtures m accordance} with'the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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r 3 Owner Address
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J , By �1'll'/1.o'n es ' Address 9Z40
O CONTRACTOR, AGENT
— w Phone �9G—�rGJ
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s State License ApprovedWILLIAM D. 13ENEVICH
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0 PLUMBING INSPECTOR
FIXTURES I NUMBER 11 MAIN DRAIN
UNITSI FEES I UNITS FEES
Water Heater Size
Water Closet Material
Bath 'Cub 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 Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&'fray To Curb
Dental Unit
Drinking 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
Vac Breaker
Skimmer
Filter
Permit Fee 2�'6
Total 'Total Fee p