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51130 I �, LOT NO. NO. STREF. APPLICATION FOR PLUMBING PERMIT W CITY OF CUPERTINO !lam-r' Sanitary \u. f 0Joh 0 < Date ® Dr — Permit No. W IJUN 22 1967 Fee $3 ,12 2 LL ' 0 Application is hereby made to the City of Cupertino for a permit to install plumbing 'o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices > and/�'�('�x�ure©IF a�d r e¢ if¢� provisions of the Plumbing Code of the City of a w Cupertino, and all of ler laws app icable thereto. wz LL Use of Premises 00 > 0 3 Owner - ddress /0 ,34/ ZJ z By /Z41 Address �•�iZ. w�/" CONTRACTOR, AGENT --V 3 ` 377- ..,7i,3ri – Phone w z a o State License��� �aApproved GC/��• U / PLUMBING INSPECTOR 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 I Sewer Box Waste Disposal Wash Tray STORM DRAINAGE Washin Machine 'S, 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 Stocm Drain Fee Sprinkler Valve Water Sys.Fee Relief Valve Gas Fee Vac Breaker _ Skimmer Filter Permit Fee `= Total Total Fee