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1062 10.312 I i�Esr� �, �� LOT NO. ..3 r/ �y NO. STREET I,tON FOR PLUMBING PERMIT " nn� OF CUPERTINO Date ��J �• 1�0 Permit No. O /b /Y 1 Fee$ c�l �I� r�J F jfn�(� �(v • �s App ca on Is here ld NDGty 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 �/ :a Owner otd T" Du7?—I Address By Address ICONTRACTOR, AGENT ryi\ Phone Approved PLUMBING INSPE R ��UBES I NUMBER--�—MAIN DRAIN I UNITS I FEES II JUNITSI FEES Water Heater 11 Size a Water C osets Material Bath Tubs To Curb Showersr, / �� To Prop. Line Lavatories 11 To Existing III Kitchen Sinks N Coq Dish Washers %Ewen EI ,E8 Waste Disposals Wash Trays STORM DRAINAGE Washing Machines] Size Water Softeners Material Bar Sinks To Main Drain Comb. Sink a Trays To Curb Dental UnitsDrinking Fountains � II Floor Drains WATER SYSTEM Hoppers Size ��l_ Restaurant Sinks �� Material n1j Sand Traps TOTAL FEES Urinals Fixture Fee M00 Area DrainsF Main Draih Fee , Water Leaders Storm Drain Fee Sprinkler Vaivcs I II Water Sys. Fee i Permit Fee p a TOTAL_ �� TOTAL FEE • EC RD ECTION Partial Rough Rough Ccbnplet Final „? 0 E3 i . � � / / � , : \ ��� � � P :� � � ƒ \ _ . g & �,j ei \�\ E3 � El ° °