51028 LOT NO.
NO. STR .
AMICATION FOR PLUMBING PERMIT
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z z< o I Y OP CUPERTINO
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zr Y Sanitary,anitary' No.
a s Dat _ Permit No. Jr
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o �{/�'��? I a on ler ' ade to the City- of Cupertino for n permit to installplumbing
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LL all 1TI (/-y��'�
t- pipes anU OC Tr:Irnr I �y verse
o � e�{� pI e se side hereof, and agrees to install said rices
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and/or fixtures in accurdancc w 1�Le provisions of the umbin Code of the -It' of
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a w Cupertino, and all other laws applicable thereto.
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a o ;tate Approved_fL
U PLUMBING INSPECTOR,
FIXTURES a
UNITS FEES UNITS FEES
'.Vater Heate Size
Water Closets Material
Hath 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_& Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
+Le�Persr�TE � Size
Restaurant Sinks Material
ps t TOTAL FEES
Urinals Fixture Fee
Area Drainam Drain Fee
Water Leaders Storm Drain Fee
spri ler Valves Water Sys. Fee
Permit Fee �z
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final