913td
• LOT NO.
D1
�S R 'jCM60 R PLUMBING PERMIT
�•�-Ci d
CI F CUPERTINO
Permit No.
Fee $ , � --•�
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
J
CONTRACTOR, AGENT`
PLUMBING
UNITS
FEES I I UNITS I FEES
Water Heater 1
�I Size
Water - Closets
Material
Bath Tubs
To Curb
Showers
To Prop. Line
Lavatories
To Existing
Kitchen Sinks
Not Coon.
Dish Washers
SEWER BOXES
Waste Disposals I
II
Wash Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners I / I
Material I i
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Storm Drain Fee
Drinking Fountains I
I
Floor Drains
WATER SYSTF
Hoppers
Size
Restaurant Sinks I
1 II Material
Urinals
Fixture Fee
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Varves
Water Sys. Fee
Permit Fee
TOTAL
OTAL FEE
RECORD OF INSPECTION
Finali /�'".'�_ /L V'' 1