2337 LOTNO. � J
NO. STREET
ON FOR' PLUMBING PERMIT
CUPERTINO
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o Sanitary No. _.
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0 Permit No.�^_ �3 3
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W 4Al Pee $ 00
° CIHYpI fionCU1FrERTaide'Qto 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
rand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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Use of Premises f FA^-'`
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PLUMBING INSPECTOR
FIXTURES D ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater I Size
Water Closets Matrria'_ (�
Bath Tubs To Curb
Showers t To Prop. Line
Lavatories To Existing
Kitchen Sinks I Not Conn.
Dish Washers 11 Sewer Boxes
Waste Disposals /
Wash Trays STORM DRAINAGE
Washing Machines ( Size
Water Softeners Material
Bar;Sinks .To Main Drain
Colhb. .Sink n Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size (u
Restaurant Sinks Material cQe
San Traps TOTAL FEES
Urinals Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Vvves Water Sys. Fee /
Permit Pee .po
TOTAL TOTAL FEE / 4y4 . p0
RECORD OF INSPECTION
Underground Rough... - -O -1
.Partial Rough..
.Rough. Complete- .3
\lain Drain
Final...
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