2164 (2) LOT NO.
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I) and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Z w Cupeitino, and all other la applica le thereto.
aUse of Premises
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-uY/ PLUMBING INSPECTOR
ATtT DRAIN
UNITS FEES UNITS FEES
Water Heater Size n
Water Closets MatcrW
Bath Tubs To Curb
Showers To Prop. Line
Lavatories �, To Existing
Kitchen Sinks 0 Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM I
Hgppers Size �/
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ,
Area Drains Main Drain Fee ,
Water.Leaders Storm Drain Fee
Sprinkler Vaives Water " Fee Fee V
Permit Fee t
TOTAL / , TOT FEE
RECOR OF SPECTI N
Underground Rough.:.
-.Partial Rnugh.. �„
Rough. Complete.. � �.
Main Drain
Proal...