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2048/O SSI • LOT NO. NO. SMET &APPL'ICAYIOhNI FOR PLUMBING PERMIT C1JY OF CUPERTINO P � f 9 196 Date 3 , Igo Permit No. a © -0VT CIT OF Cs I ERT," Fee $0_ 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 other laws applicable thereto. FIXTURES I NUMBER 11 MAIN DRAIN I UNITS I FEES II 1UNITSI FEES Water Heater Size t Water Closets Material Bath Tubs To Curb Showers To Prop. Line Lavatories To Existing Kitchen Sinks Not Conn. Dish Washers 11 Waste Disposals Wash Trays STORM DRAINAGE Washing Machines Size Water Softeners Material Bar Sinks �� To Main Drain Comb. Sink a Traysl 1 11 To Curb Dontal Units Drinking Fountainsl I 11 Floor Drains WATER SYSTEM Hoppers Size Restaurant Sinks II Material Sand Traps TOTAL FEES Urinals Fixture Feej/'00 Area Drains Main Draih Fee Water Leaders Storm Drain Fee Sprinkler Valves Water Sys. Fee /.Q 0 Permit Fee O TOTAL I I I Lob TOTAL FEE . D D ' RECORD OF INSPECTION