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51140 (2) No. Street Lot No. ° jas66 y � � �? APPLICATION`FOR PLUMBING PERMIT 1CITY OF CUPERTINO U ` /DEC 20 196Aamtary No. C F E Date � Permit No�1�S�11 o �I �LpY�n © Fee $" OCA 3 s Application is hereby made to the City of Cupertino for a permit to install plumbing In 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 Codeofthe City of Cupertino,and all other - '2 laws applicable thereto. m 0 m ro Use of Premises p U ° Owner 0 ptrAddress 66 o °J c ro _ m By Address9.5�; 3 « Contractor,Agent d ° Phone /ZU J. m 3 _ = a �/ 20 »� State License i Appro ✓/ Plumbin�spector 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 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 Area Drain Main Drain Fee Water Leader Storm Drain Fee Sprinkler System Water Sys. Fee Relief Valye 11 Gas Fee Vac Breaker Skimmer Filter Permit Fee Total Total Fee