51121 /Dol%/ I S& ' a LOT NO.-!2n 1
NO. STREET '
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ON FOR PLUMBING PERMIT
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:ITY OF CUPERTINO
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0 < Uate 196 Permit No
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Fee 5 . O UCITYoAppl ionGPTvo te City of Cupertino for a
permit to install plumbing
'o < 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
a w Cupertino, and all oth ws applicable r o.
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a o State Licens Approve
`kb PLUMBING INSPECTOR
FIXTURES NUMBER
UNITS I FEES UNITSI FEES
Water 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
'Waslh Trays I STORM DRAINAGE
Washing Machines I Size
Water Softeners /,001 Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee /,00
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee 00
Permit Fee
TOTAL ,V0 TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final