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51187LOT NO. %J APPLICATION FOR PLUMBING PERMIT 11 �ILw' Y OF CUPF.RTINO �q, Sanitary No. SJJ'SDace / - . iq 8196 Permit No SZt k 7 Pee $ �2 �- 0 Application ,.�s-hereb Itt>^ydc%;Rh�City of Cupertino fora permit to install plumbing pipe{vnTyor rfix'furesati�fcr411the 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. Use of Premises aa: OwnAd �Ad CONTRACTOR, AGENT Phone State License Approved WILLIAIt9 D. GEtiEVICH PLUMBING INSPECTOR X, 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 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 Valve Water Sys. Fee Relief Valve Gas Fee Vac Breaker _ Skimmer Filter Permit Fee Total // Total Fee a Ira