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APPLICATION FOR PLUMBING PERMIT
a ` � CITY OF CUPERTINO
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Fee $ {2_
o ° W�IfalPrnflY0lTsLlILl�hWl/t the City of Cupertino for a Permit to install Plumbing
a W If sLjllt! Ithe 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 other laws l J applicable thereto. /
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-U PLUMBING INSPECTOR J
FIXTURES INUMBER I MAIN DRAIN
Units I Fees Units Fees
Water Heater Size
Water Closer Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Not Conn.
_Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain 1
Floor Drain WATER SYSTEM
Ho r Size
ink Y Material
Sand Trap TOTAL FEES
Urinal ev Fixture Fee --d
Area Drain Main Drain Fee
Water Lea er Stotm Drain Fee
Sprinkler System Water Sys. Fee
S�
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee ry