51046 (2) IAa JG-61'9'ao 'G, TOT NO.
NO. ST EP.T
/kP [ EfFO PLUMBING PERMIT
1P CUPGRTINO
° ?, JNOV 24 1 7 Sanitary No.
w -7 _
0 < Date 6 1967 Permit No u
u
r LL �NPee S3. �
° e AppGTv iP4,Vreb,UAQdP > of Cupertino for Permit to installP
plumbing
`o 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 laws applicable thereto.
LLUse of Premises
00 �
3 Owner /i �� ✓`R�c AddressiXUD
By RAYNE SOFT WATER SERVIPdEss
J o y CONTRACT , A ENT
a SANTA CL1RA, CALIFORNIA 95050
— w Phone
w z Phurk r-oct
¢ a a�y�r Approve dWILLIAM D. BENEVICH
o State License
U PLUMBING INSPECTOR/
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater 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 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 TO'T'AL 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
Total Total Fee