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51064 LOT NO. NO. STR It Ll' ION FOR PLUMBING PERMIT a Cl" OF CUPERTINO xo ��p sanitary No. OA CGi _ ° Q 19 Permit No. i 4 PSV (��[� tee S ° �ication i h made to the City of Cupertino for a permit to install plumbing o a pip s and/( � res listed on reverse side hereof, and agrees to install said prices > and/or IreSriri accordance with the provisions of the Plumbing Code of the City of a w Cupe�T� , and all other laws applicable thereto. wz j .. Use of Premises ,,�/ -• / O O L o a Owner/ ice /C �L��/ Address �©��/Z .>�« 9 Z J ys l 3s 7 S- � ° By � T (/ Address CONTRACTOR, AGENT 3r a N (__ — _ Phone U z T• 7-3/- ww ¢ a �� -� y� Aroved /' a osta[e License pp U PLUMBING INSPECTOR FIXTURES INUMBER I MAIN DRAIN Units Fees I Units Fees Water Heater Size Water Closet Material Bath Tub LTo Curb Shower To Pron. Line Lavatories To Existing Itchen 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 Fe", Vac Breaker Skimmer Filter Pool Sweeper / Permit Fee Total Total Fee J�