51167.1LOT NO.
ANO. STREET
14PPLIC TION FOR PLUMBING PERMIT
C,.ff�Y OF CUPERTINO _
x 00 � Sanitary No. // Z
0 aUatd N 2 1967 ;v196;2 Permit No
w 4 _ Pee $ 2342—
° A4' R i(ator s I` ri rr{a t t t1 e Cit of Cupertino fora permit to install plumbing
' w . A u "s.' r. I ,4, � Y P Pe P. A'
0 r pipes and/ Ttxtures listed oii 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
< w Cupertino, and all other laws applicable thereto.
w x
r r
LL Use of Premises
1644feOzo 4-
0 0 7 �o79f ✓ F/
> N / /
r 3 Owner Address
z By Address
O CONTRACTOR, AGE
— m Phone
W
a �y e�'LLIAMI D. BENEVICH
0 o State License ��/ G�j�— Approved /
- U PLUMBING INSPECTOR V
FIXTURES
—1
NUMBER
MAIN DRAIN
UNITS FEES
UNUS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
/
To Curb
Shower
;;
To Prop. Line
Lavatories
12-
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Trey
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & TroyTo
Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee i
Water Leader
Storm Drain Fee
$ rinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee 3