51114 I' LOT No.
APPLIC�AT N FOR PLUMBING PERMIT
Z i �. 1DEC 1 j��7 I CITY OF CUPERTINO
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0 Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i and/or fixtures in acco ante with the provisions of the Plumbing Code of the City of
w Cupertino, and III ner aws appli I heret(6
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U P PLUMBING INSPECTOR
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•I. NUMBER
UNITS FEES UNITS FEES
IXWater Heate Size
Ulster Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavaturies To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Nater Leaders Storm Drain Fee
Jprinklct Valves Water $y'S. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final