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51189 (3)0 E 0 U E m `0 3 s No. Street /� Lot No. d000�'L6W13Keck APTS) APPLICATIO FOR PLUMBING PERMIT FEB 2 1971 CITY OF CUPERTINO /" A J Date ,199% Sanitary No. Permit No.S/i Fee $3.5o 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 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other laws applicable thereto.,// Use of Premises f1' -7:^ Owner �Address By!<%(/J Y 'ZN Addresses GNU Contractor, Agent S. ' ,✓� ���./�/m/SSC Phone % �S2 - 7, /7,! ,� State License �� 7 �� Approved ,.wK,7U ' Plumbing Inspector FIXTURES NUMBER Units Fees Water Heater Water Closet Bath Tub Shower Lavatories Kitchen in Dish Washer Waste Disposal Wash Tray Washing Machine Water Softener Bar Sink Comb.Sink & Tray Dental Unit Drinking Fountain Floor Drain Hopper Restaurant Sink Sand Trap Urinal Area Drain Water Le der Sprinkler System Relief Valve. Vac Breaker Skimmer Filter Total MAIN DRAIN Units Fees Size Material To Curb To Prop. Line To Existing Not Conn, STORM DRAINAGE Size Material To Main Drain To Curb WATER SYSTEM Size Material TOTAL FEES Fixture Fee Main Drain Fee Storm Drain Fee Water Sys. Fee , Gas Fee Permit Fee 2.O Total Fee