1062 10.312 I i�Esr� �, �� LOT NO. ..3
r/ �y NO. STREET
I,tON FOR PLUMBING PERMIT "
nn� OF CUPERTINO
Date ��J �• 1�0 Permit No. O /b /Y
1 Fee$
c�l �I� r�J F jfn�(� �(v • �s
App ca on Is here ld NDGty 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 �/
:a
Owner otd T" Du7?—I Address
By Address
ICONTRACTOR, AGENT
ryi\ Phone Approved
PLUMBING INSPE R
��UBES I NUMBER--�—MAIN DRAIN
I UNITS I FEES II JUNITSI FEES
Water Heater
11 Size a
Water C osets Material
Bath Tubs To Curb
Showersr, / �� To Prop. Line
Lavatories 11 To Existing III
Kitchen Sinks N Coq
Dish Washers %Ewen EI ,E8
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines] Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink a Trays To Curb
Dental UnitsDrinking Fountains � II
Floor Drains WATER SYSTEM
Hoppers Size ��l_
Restaurant Sinks �� Material n1j
Sand Traps TOTAL FEES
Urinals Fixture Fee M00
Area DrainsF Main Draih Fee ,
Water Leaders Storm Drain Fee
Sprinkler Vaivcs I II Water Sys. Fee i
Permit Fee p a
TOTAL_ �� TOTAL FEE
• EC RD ECTION
Partial Rough
Rough Ccbnplet
Final „?
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