51015 (2) LOT NO.
NO. STREET
�A L LUMBING PERMIT
z < '� I h ERTINO
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x MAY 31 1968 t sanitary No.
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o Date 196_ Permit No. .S / O/ b�
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CITV �r �r��FppTInn //�� Fee $
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O Application islhereby madV 61tKerCity`olflupertino for a permit to install Plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r 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.
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Use of Premises /
00
3
Owner Address
Address
oz 13,vaTL( "f �(. ,t/t. ti� Address 3
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CONTRACTOR,AGENT
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Phone 736 303 S
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rc a ( �6 9! 7 7
Approved WILLIAM D. BENEVICH
a o State License
_ U INSPECTOR v
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NUNtBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Hcate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Pee
Z�/ater Leaders Storm Drain Fee
sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drai
Final
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