51179LOT NO.1
NO.
q�fh�IC FOR PLUMBING PERMIT
® AA
I F CUPERTINO
Sanitary No.
V 6 1967 „7 9
Date f9 Z Permit No J
p n1�(� Fee $ ;! S. VV
App " is�bFrebC&ERTg4`uu3' of Cupertino for a permit to install plumbing
pipes a/br' 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.
WILLIAM D. BENEVICH
State License ��G�%% Approved
PLUMBING INSPECTOR ✓
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
/ Size
Water Closet
Material '
Bath Tub
To Curb
Shower
/ To Prop. Line v
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Troy
STORM DRAINAGE
Washin Machine
Size
Water Softener
Material
Bar Sink.
To Main Drain
Comb.Sink&Tmy
To 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 SC9'C
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /•
Relief Valve
Gas Fee S
Vac Breaker
Skimmer
Filter
Permit Fee �{l
Total
J Total Fee SZ