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NO
�PP.L1 ION FOR PLUMBING PERMIT
iCITY OF CUPERTINO
All
9�Q Permit N
T n, Fee $ y
Application Is hereby'ardOto the City of Cupertino for a permit to install plumbing
k; pipes AdXtures listed.on the reverse side heieof, and agrees to.install said prices
i' °and/or fi q in accordance with the provisions of the Plumbing Code of the City of
Cupertino, fall other laws applicable thereto. }
,, P Use of Premises `{
u O
h Own 1a�' Addtes
,, co ran n Ac r �
Phone° Approve
PLUMBING INSPE670P,
FIXTURES' I NUNlBER71 MAIN DRXIN a
UNITS FEES IUNITS I FEES
'Water Heater 11 Size
Water Closets I 11 Material
,'_Bath Tubs 11 To Curb rL
'Showers I 11 To Prop. Line jj ..4; -1
Lavatories 11 To Existing
'Kitchen Sinks h 11 Not Conn. I ' ` ,
Dish Washers � ' '{� ;� ^•+ ,
'Waste Disposals d 11
;Rash Trays 11 STORM DRWIINAGEW-Zd'
Washing Machines Size
water Softeners Material', . �� t,,l P,;Q
Bar Sinks 11 To Ma'i'n.Drain'qjM' ;J;-
Comb Sink s Trays
Dental Units I
Drinking Fountains I
Floor Drains WATMR wSTEM
Hoppers Size
-Resl:,rant Sinks Material
,Sand Traps TOTAL F,tEES r;ro
Urinals Fixture
�iArea Drains - Main Drain NNel
g m
"Water Leaders Storm Drain^;F.ee, l
WFee '
Sprinkler Vmves ater Sys. r-
mit Fee
TOTAL / 11 TOTAL FEE "
RECORD OF INSPECTION y► '
Partial Rough
'Rough Com lete
t'-Firial
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