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z a OF CUPERTINO
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x oSanitary No.
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0 a Da RTINQ96 Permit No e.
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises _1
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3 Owner_ Address
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State License`!� `''i _Approved
l) CONTRACTOR, AGENT
FIX'I URES NUN BER MAIN DRAIN
UNITSFEES UNITS FEES
Watcr Heater Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
lXlater Softeners (,O Material
m's To Main Drain
CHntl?"3fn1F s Trays To Curb
Dental Units _
Drinking Fountains
Moor Diainsr , WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vaivcs Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD'OF INSPECTION
Underground Rough,..
.Partial Rough-
Rough
ough..Rough. Complete..
\Iain Drain
Final...