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51143 (2) g7lm I tIA 'V' LOT NO. NO. STREET CITY OF CUPERTINO OF CUPMM z APPLICATION FOR PLUMBING PERMIT Sanitary No. rcLL M V h7 0 �i Date , 19 Permit No 3 ` O PAID Pee $--4 1 LL o Application is hereby made to the City, of Cupertino for a permit to install plumbing o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices > f 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. Use of Premises N S T 00 > 0 3 Owner4o�t i.4 ATC 4 /t1C'0%-/4LAddress 2 70 V C S 5 A � L' 0a z J � z py ?) A i� Z fa �r! " n fS :� 9 Address '2 BG 3 6 C/.1.4 1'5f C T . O CONTRACTOR, AG ENT 3Q — Phone2 5 1 7 / 5 y w z w w co State License 2 S S o 20 Approved UiI PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN Units Fees Units Fees Water Heater Size Water Closet Material Bath Tub To Curb Shower To ProD. Line Lavatories xi tin Kitchen 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 Ass Area Drain Main Drain Fee Water Leader Storm Drain Fe Sprinkler System Water Sys. Fee Relief Valve 11 Gaq Fee Vac Breaker Skimmer Filter Pool Sweeper Permit Fee Total Total Fee 7.