2146 LOT NO:_
NO. fi
® �Ps
TIA�IJ� FOR PLUMBING PERMIT
m a l� OF CUPERTINO
x o /JUN 1 1 63 Sanitary No. /
a 4 p
0 a Date 196J� � Permit No '�2
LLCITY OF CUPERT°n'^ Pee $
O 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 laws applicable thereto.
W x _
Use of Premises
00
50
o a Owner iL.n 't") Address– - �
ZJ �o By C� Address
F CONTAACT00., AGENT
– a Phone —V
WZ
W W
z a 171 7 D. BENEVICH
a o State License T-App,o,edWILLIAM
_Ug/
✓J PLUMBING INSPECTOR
FIXTURES NUMBER I DRAIN
UNITS FEES UNITS FEES
Water Heater / /.G'7l Size �' q .�
JID-inking
Xrater Closets „? ,z.ffU Materia: G^
ath Tubs or[� To Curb
howers .o'U To Prop. Line
avatories ,tn7 To Existing
itcben Sinks .pT Not Conn.
ish Washers Sewer Boxes ou
Waste Disposals
Wash Trays STORM DRAINAGE
ashing Machines ,e2r Size
Water Softeners Material
ar Sinks To Main Drain
omb. Sink % Trays To Curb
,ntal Units
Fountains
Floor Drains WATER SYSTEM
iSizeestaurantSinks Materialan Traps TOTAL FEES
Urinals Fixture Fee li�l
iAre:i Drains Main Drain Fee V-v
\eater Leaders Storm Drain Fee
Sprir,'KIer Vaivcs Water Sys. Fee yd
Permit Fee O-V
TOTAL yam' TOTAL FEE p-v
RECORD OFINSP
Underground Rough. . _ -3
.Partial Rough- .1Z
.Rough. Complete.. QX,
\lain Drain
Final---
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