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1905 (2) LOT NO. Via NO. S j APPL a!I N. FOR PLUMBING PERMIT 3 All 7 ��53 Lam.'- OF CUPERTINO v Date Z— 33 19TH Permit No. CITY G:'. V L NIV � Fee a ✓9 Application is hereby made to the 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 Oth laws applicable thereto. 8 Use of Premises 'a K1"UMBWG AddresAddresAPprov I URES NUUMBER M R I I UNITS I FEES UNITS FEES Water Heater I / I I Size I Water Closets i 2Material Bath_Tubsj 7 I To Curb Shower I / I Ta Prop. Line I I Lavatories I $ I To Exis ' g Kitchen Sinks I I No on Dish Washers I / I I SEWER BOXES OR�17 Waste Disposals Wash Trays I STORM DRAINAGE Washing Machines I I Sue Water Softeners Material I I Bar Sinks I To Main Drain Comb. Sink &Trays) I I To Curb Dental Units I I II I Drinking Fountains) I 11 I Floor Drains II WATER SYSTEM Hoppers I I Fize 1. Restaurant Sinks I I I Material Sand Traps I I II TOTAL FEES Urinals I I I� Fixture Fee ,,, I ,.•._ Area Drains ( I Main Drain Fee I ; ..�- Water Leaders I I Storm Drain Fee- at . S s Fee —o Sprinkler Vawes I Y � ��-. 'iF•`� II Permit Fee TOTAL TOTAL FEE / 04; RECORD 9E.,INTION Partial Rough Rough Complete�j Final •e. IW °cTI V imn tz ro ro it to