51043.1 (2) �d'fe O LOT NO.
NO. XTtLT
® F'QR PLUMBING PERMIT
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i _ IT OyI�1CUPLRTINO
w Z f MAY 6 1968 Y
s ¢ Samtar No.
y O /
¢ '--S / C /
o Date 19( Permit No
w U Fee $ -7
= LL rtTY �F
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 2 � y-�
r
a Use of Premises �� 2J
00
r3 Owner Address
o a A/n_
z By Address /3/ SS
O CONTRACTOR,AGENT
3 i 3 j-% o v �JoZs
— Phone
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a LL 5 ai 6 Approved WILLIAM D. BENEVICH
a Stare License
PLUMBING INSPECTOR
r
I.
UNITS FEES UNITS FEES
`.Crater Heate Size
Water Closets Material
Bath Tubs To Cu
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposals
aTh Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Flax Drains WATER SYSTEM
Hoppers ize
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
`prinki, Vales Water Sys. Fee
Permit Fee ° a
TOTAL TOTAL FEE 7
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.vlain Drain
Final