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51226C 0 E 0 U `c E Y 3 s No. Street CITY OF CUPERTINO JUL 21 1971 Lot No. /eO APPLICATION FOR PLUMBING PERMIT CITY OF CUPERTINO DA ' D ate 4 — 'zL/ , 19t�.� Sanitary No. Permit No. Fee $'3•S -Z) Application is hereby made to the City of Cupertino for a permit to install plumbing pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures in accordance with the provici,Tns of the Pit bing Code of the City of Cupertino, and all other laws applicable thereto. Use of Premis Owner By Cooj�trac�t' Phone�Z=C State License 1/ Approved Plumbing Inspector FIXTURES NUMBER MAIN DRAIN Units Fees Units Fees Water Heater 1 Size Water Closet Material Bath Tub To Curb Shower To Prop. Line 97 Lavatories To Existing Kitchen in 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 t/ Sand Trap TOTAL FEES Urinal Fixture Fee Area Drain Main Drain Fee _ U Water Leader Storm Drain Fee Sprinkler System Water Sys. Fee (� Relief VMye Gas Fee, 5-0 Vac Breaker Skimmer Filter Permit Fee _ t.2 Total Total Fee 0