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NO. STREET
LOT NO. 17f'
�L�CA N FOR PLUMBING PERMIT
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�'1I1pp7 ti1Y OF CUPERTINO
i OV A I96 Sanitary No.
Date 196z Permit No (—//67,/
0 (� Fee $ of 3 4�
CAIppfica'OFis"llpEADNto`fhe City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
/ 9s -41p %
Ow ( �Address
py���r. ���a��Coe�1 Address
CONTRACTOR, AGENT
Phone—
State
hone
State License
Approved WILLIAM D. 13ENEVICH
X PLUMBING INSPECTOR !--
FIXTURES I NUMBER �� MAIN DRAIN
UNITS FEES UNITS I FEES
Water Closet I -I-' 1 11 Material lel
To
Kitchen Sink
Dish Washer
Machine
Water Softener
-11 Material
Bar Sink
H To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper ..
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stom Drain Fee
S rinkler Valve
Water s. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee az�,
Total
Total Fee lull - J