51043.1 (9) 2,a f'D O Iy� 4. e'4 LOT NO.
NO. STREET
N APPLI�CAT PLUMBING PERMIT
.z E CUPERTINO
r O �" tgca Sanitary No. 1
o Date AI 6 196 Permit No
U Fee 3
� ° ApplicatictnliSQferetPyFma�ej�¢"Q6e I o y' Cupertino for a permit to install plumbing
o a pipes and/o!fi�t res-hated 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.
wx
Q ~ Use of Premises
J LL
00
r 3 Owner Address
z By Address /11 T C'
° CONTRACTOR, AGENT
3 W �
- W Phone SG - 2 1-�'t'
w z /
R2 State License 2 r J Approved WILLIAM D. BENEVICH
a La' / 5 �O
WPLUMBING INSPECTOR
FIX I URES NUMBER MAIN DRAIN
_
`X/atcr Heate UNITS FEES $¢e UNITS FEES
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Si Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
X ash Trays STORM DRAINAGE
Was Ing Machines Size
Water.Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
I+lour Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Unna s Fixture Fee
rea rains Main Drain Fee ,S o_°
ZV/ater Leaders Storm Drain Fee
Sprinkler val,ca Water Sys. Fee
Permit Fee a �'
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final