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51767.1 LOT NO.Z-I NO. STREET SiAPPLICAT;ION FOR PLUMBING PERMIT i SZ �._�� CITY OF CUPERTINO 7 / r rc t C 1961 Sanitary No. Irl ° Date 196 Permit No. J /7t'o 7, / a 3.. " ITt1 r. nl r r a Fee S r ° �Application'is hereby[1nadel�o�he Cit}' of Cupertino for a permit to install plumbing o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices r r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of i w Cupertino, and all other laws applicable thereto. w x r r Use of Premises 00 oleJrrf�f�` <� r 3 Owne �L d�idi�� Address ° j o B '�/"/Cvni_T Address�� 3 o CONTRACTOR, AGENT Phone w z rca Appro �OU�/7 11 02 State License v,�OIulnrn D. ©ENEVICH a o �7' U PLUMBING INSPECTOR ,/ FIXTURES NUMBER MAIN DRAIN UNITS -FEES UNITS FEES Water Heater / Size Water Closet Material 4i/ Bath Tub / To Curb Shower To Prop. Line Lavatories "ro 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 WA'T'ER SYSTEM Kopper Size Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee Area Drain Main Drain Fee Water Leader Storm Drain Fee Sprinkler Valve Water Sys.Fee /Fill Relief Valve as Fee Vac Breaker Skimmer Filter Permit Fee o2 Total ZtLIV Total Fee licSa