51001.4 (2) 7, I - `• LOT NO./Q 9
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SanitarFOR PLUMBING PERMIT
(} Qh Y OF CUPERTINO _
f ¢ JUL 19 � 60 No. , 702.
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3 < Date �V 96_ Permit No
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all r laws applicable thereto.
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a a 93.T Approved WILLIAM D. BENEVICH
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State License
p//J U �pJ.LIMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Renter Isize
Water Closet Materiel
Bath Tub To Curb
Shower To Prop. Line
Lavatories 41 To Existin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Dis
Wash Tray STORM DRAINAGE
Washin Machine Size
Water Softener Material
Bar Sink To Maial6n
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap T,0 AL FEES.
Urinal Fixture Fee
Area Drain I Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee J- 3-0
Relief Valve Gas Fee 4y
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee