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51016.1 LOT NO. NO. STREET ,,,APPLICATION FOR PLUMBING PERMIT co OF CUCITY OF CUPERTINO wz r 0 NDY 1 1971 Sanitary No. 01 Date/ �' �'� I � Permit No 574016-1 i LLP p U Fee S 444-0 O Application is hereby made to the City of Cupertino for a permit to install plumbing 0 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 applicable thereto. wx < r 14 Use of Premises f?ia/hs.!_crr Sim.-S�E t�i11y��/ 00 oJ Owner��L '17�� !� Address Address O CONT TOR, AGENT 3 � G'jaei9- - uai Phone,O9 wz ww ¢ a a o State Licenses�'DSya Approved / U I PLUMBING INSPECTOR v FIXTURES NUMBER MAIN DRAIN Units Fees Units Fees Water Heater / Size I / Water Closet Material c 'Bath Tub / To Curb Shower To Prop. Line Lavatories To Existing Kitchen 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 jgoc d. Sand Trap TOTAL FEES Urinal Fixture Fee Area Drain Main Drain Fee Water Lea er Storm Drain Fee _ Sprinkler System Water Sys.Fee d� Relief Valve Caq Fee Vac Breaker Skimmer Filter Pool Sweeper Permit Fee Total // Total Fee " G J