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51046 ! ) If / 1 XU LOT NO. NO. STREE.I' APPLICATION FOR PLUMBING PERMIT ITY OF CUPERTINO .W i1/ .r z 0 V te Sanitary No. tt// 0 LL o a Date 196— Permit No r V 3 I . Fee $� W a p � pip ; ho is herebymade to the City of Cupertino for a permit to install plumbing `o w /o�� to � i �1f{�reverse side hereof, and agrees to install said prices > 1- and/or fixtures in acco'rd�l5te 'i�f1'the provisions of the Plumbing Code of the City of a w Cupertino, and all other laws applicable thereto. W x � r Use of Premises 00 > m 3 Owner �>o L Oa/' Address ZJ �� 1 3 J , By D`4--�'�'�o �.sc Address�iQbD sY/GT��9 �x oy O CONTRACTOR, AGENT 6� - am Phone 7 W z W W a u s State License Approved WILLIAM D. ©ENEVICH ao U — PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN UNITS FEES UNITS FEES Water Ileater Size Water Closet Material Bath Tub To Curb Shower To Prop. Line Lavatories To Existing Kitchen §ink 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 \1aterial Sand Trap 'TOTAL FEES Urinal Fixture Fee Area Drain Main Drain Fee S� Water Leader Storm Drain Fee Sprinkler Valve Water Sys.Fee Relief Valve Gas Fee Vac Breaker Skimmer Filter Permit Fee o]- Z Total Total Fee 7 6 t!