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51129 1QS'�C? c'Y�tSS No. Street Lot No. o — i0 CRY OF CUPERTINO APPLICATION FOR PLUMBING PERMIT MAR 10 1971 CITY OF CUPERTINO Sanitary No. c AA E `PP Date" D _ 19 Permit No. ,$ W1.2 9 0 3 Fee 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 o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other .� laws applicable thereto. pM L`� tS m A Use of PremisesS tC o ��jr Owner(" Tl•UF'�1—s Addressl V S 7U G!K ESS a v, By SVr4 F t" Address Contractor,Agent °' ° Phone Z�1 j CLt State License ' U-1 Approv bing 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 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 WATER SYSTEM Hopper Size Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee Area Drain Main Drain Fee Water Leader Storm Drain Fee Sprinkler System Water Sys.Fee Relief Valve Gaq Fee Vac Breaker / Skimmer Filter Permit Fee .2 "- Total Total Fee /