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51075.1 (4) gar I REFI LOT NO. h0.O. STREET '�•'I• APPLICATION FOR PLUMBING PERMIT AV r i�if.�T CUPERTINO x o Sanitary No. o a DateG 268 Permit No 3� Pee $ 0 1 LL ' 0 ApplicGITYis 0C bXU ERT4K e 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 > and/or fixtures in accordance with the provisions of the Plumbing Code of the City of a w Cupertino, and alother laws applicable thereto. 0 LL Use of Preml s 00 � /� yG p I k i(Add 0 3 Owner + ress °J �`� L,�A,01s r o gy �n 00-W lC e r t- Address 3 F qCO �R, AGENpT — m Phone / Sp S 9 w z w w 'y'1/2i Approved tL.p.✓ WILLIAM D. SENEVICH a o t State License U PLUMBING INSPECTOR FIXTURES NUMBER MAIN DRAIN UNITS FEESUNITS FEES Water Heater Size Water Closet Materiel CZ Bath-Fub To Curb Shower To Prop. Line Lavatories To Existing Kitchen §ink 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&Tmy To Curb Dental Unit Drinking Fountain Floor Drain WATER SYSTEM Hopper Size Restaurant Sink Material d Tra TOTAL FEES Urinal Fixture Fee 16d. S-0 Area Drain Main Drain Fee Water Leader Storm Drain Fee kBreaker Water s.Fee Gas Fee Permit Fee - Total 147 /Od, Total Fee oSb