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51131 No. Street I Lot No. ° UlY J E t�PEitfIN0�1./C/F�i/L �U�� E t R 1 1971` APPLICACITTY OF CUPERTITION FOR ING NO PERMIT O yp A p Sanitary No. .G E Date:? —11971 Permit No. .S—� ° Fee S� 3 s 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 0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other laws applicable thereto. w n Use of Pretmises .JCE /cEJi o ° Owner l�©.2f/�'fAj Address .,�U~6`I- 1.=-1 rJ,: Do G � 1 = N BY L�i` 1l�� Y/ rh��f� Addressc560`/-j£n.1725rtj� Sl� 3 Contractor,Agent ° Phone — State License ��7��C�' Approved Plumbing Inspector FIXTURES NUMBER MAIN DRAIN Units Fees Units Fees Water Heater Size Water Closet Material Bath Tub To Curb Shower To Pro . Linc Lavatories To Existin Kitchen ink N t" nn Dish Washer Waste Disposal Wash Tra 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 Hoper 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 I Gas Fee LJ Vac Breaker Skimmer Filter N Permit Fee 2.Z)O Total Total Fee 3 16