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51015.2 (2) V! t$ 40 I LOT NO. h0. STRBF.T ' APPL �CATION FOR PLUMBING PERMIT r� d F.[tICY OG'C RL [NO w = LL /o a Date �� /�UIT , Il',9hrK Permit No wV Fee w Application ebt� rfor Itlab o pipeand/or (xturesistMon �N � dhereof, and agrees to prices > and/or fixtures in accordance with the provisions of the Plumbing Code of the City of a w Cupertino, anda other laws applicable th reto. a ~ Use of Premise J O 0 O nn / r 3 Owner A Gy-/ ,G Address J�H/F,tJS �1 '�J o z By( 1 .iiJ./.i• I //,i/ /1/n..4 Addres$�d / �'�c xw;s cCP 41 O C NTRA OR, AGENT 3 — m Phone S 6 W z f State License 3 2�! Approved a o —U PLUMBING INSPECTOR 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 Washin Machine Size Water Softener Material Bar Sink To Main Drain Comb.Sink&Tray To Curb Dental Unit Drinking Fountain Floor Drain WATER SYSTEM Hopper Sire Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee (7th Area Drain Main Drain Fee Water Leader Storm Drain Fee Sprinkler Valve Water Sys.Fee Relief Valve Gas Fee Vac Breaker Skimmer vtU Filter Permit Fee Total Total Fee Q(7