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51001.2
U ,4,L363 I meati i -S5; LOT NO. ST EFT APPLICATION FOR PLUMBING PERMIT C TY OF CUPERTINO "s�o Sanitary N Date I Permit No S%n a/ 2— Fee $ -3 Application is hereby made to the City of Cupertino for a permit to install plumbing pipes(dtl\jr f(j"ires(1��i©Tf�Qtj�erse side hereof, and agrees to install said prices and /c i tllveys�l---� acM 1 �i�si i�'��jh�1¢; provisions of the Plumbing Code of the City of Cupertino, and all other laws applicable thereto. Use of Premisesi7�'%� Owner_�� C '� //S Address d",/ C_ �' By Ps _S // Address i �c4rwl of ./% CONTRA TOR, AGEN Phone State License wApproved " �a PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Water Heater Size Water Closet _ Material Bath Tub To Curb Shower To Prop. Line Lavatories To Existing Kitchen Sink Not Conn. Dish Washer Sewer Box Waste Disposal Wash Tray STORM DRAINAGE Washing Machine Size Water Softener Material Bar Sink To Main Drain Comb.Sink & Tray To Curb Dental Unit Drinking Fountain Floor Drain I WATER SYSTEM Hopper Size Restaurant Sink Material Sand Trap TO'T'AL FEES Urinal Fixture Fee Area Drain Main Drain Fee Water Leader _ Storm Drain Fee Skimmer Permit Fee Total Fee