511461
W
LOT
NO.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Date�� — f y 196..r Permit No. Y 114
Fee $ 0�
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of
Address
Approved
PLUMBING INSPECTOR
TURES NUMBER
MAIN DRAIN
UNITS I FEES
UNITS FEES
Water Heater
Size 9/11
Water Closets
Material ['
Bath Tubs
To Curb
Showers
To Prop. Line l/
Lavatories 13 1 11
To Existing
Kitchen Sinks
Not Conn.
Dish Washers
SEWER BOXES
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines II
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink s Traysj ITo
Curb
Dental Units �I
Drinking Fountains) �I
=--
Floor Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FWS
Urinals
Fixture Fee
Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
_
Sprinkler Vaives
Water Sys. Fee , o
S°=I II
Permit Fee oZ�
TOTAL I�
TOTAL FEE
RECORD OF INSPECTION