51001.2 / 0 `7�—� 8 I C/ .�,•-CP.�E��,rP LOT NO.
NO. Sn EF.I'
APPLICATION FOR PLUMBING PERMIT
z TTY OF CUPERTINO
y0 Sanitary No.
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a Date Permit No .4%O O e- 2—
' MAY
AY Fee $3�2-j
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes a Is Irl se side hereof, and agrees to install said rices
i m and/or Y1z�t�ilfes ��tccO4l11n�iEeWlth�r »rovisions of the Plumbing Code Of the City of
a W Cupertino, and all other lags applicable thereto.
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< Use of Premises e gyred., !=
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aa Owrn 2:1— Address
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z By Address
3 O CONTRACTOR, AGENT
— mPhone Q37-2-2-eiO77
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a a WILLIAM D. BENEVICH
a o State License�-��9�� Approved
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'L PLUMBING INSPECTOR
FIXTURES D
UNITS FEES UNITS FEES
Water Heate / Size
iI
Water Closets h 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
USinksSinks Material
TOTAL FEES
Fixture Fees Main Drain Feeers in Feealvcs WaPermit Fee —2,a-d
/� TOTAL FEE 3d<_' -
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Main Drain
Final