51123 No. STXEE.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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Permit No
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1967 Fees 5
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' 0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o : pipe �a�d/ cE{xt rc �1� n the reverse side hereof, and agrees to install said rices
i arid� r fix r s ia� ydr 1� 1"i� the provisions of the Plumbing Code of the City of
a W Cupertino, and allotf�ws applicable thereto.
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a Use of Premises
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CO\TRACTOR, AGENT
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a a State License 1 ZApproved
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PLUMBING INSPECTOR ✓
FI. R . NUMBER
UNITS FEES UNITS FEES
`X/atcr Heate 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
Was-Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urinals Fixture Fee
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��r�ea Drains Main Drain Fee
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Water Leaders Storm Drain Fee
Sprinkler Volvos Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final