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51133 /0.762-68-70 LOT OT NO, NO. STR EF.i' CITY OF CUPERTINO " < APPLICATION FOR PLUMBING PERMIT zz 0 92W OP'6�7uto Sanitary No. 3 a ©Lith �n� 19Permit No -t/ j w4 Fees 3-SO xo � MplylicalonDi hereby made to the City 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 > and/or fixtures in accordance with the provisions of the Plumbing Code of the City of a w Cupertino, and all other laws a plicable thereto. .y � r a Use of Premises �.r/�.� J p 0 O 0 3 Owner / Address o a J By /lJ/n<<i,EST>^' P�.�4 Address 3 CONTRACT/ AGENT /< AGEN / — < Phone z 7 —7(�/S wqq C £ Stale License q— C Approved a o Y PLUMBING INSPECTOR IP 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 r Water Softener Material Bar Sink To Main Drain Comb.Sink&Tray To Curb Dental Unit Drinking Fountain Floor Drain WATER SYSTEM Hopper Size / •SO Restaurant Sink =Fixture Sand TrapFEES Urinal Area Drain eWater Leader eeSprinkler System e Relief Valve 11 Gas Fee Vac Breaker Skimmer Filter Pool Sweeper Permit Fee O U Total Total Fee ], ,SO