51145 02/S • �1— I LOT.NO.
NO. ��STREEI'
L1 10 FOR PLUMBING 'PERMIT
" d ® CITY OF CUPERTINO
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3AU' – �Q 6 Sanitary No.
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o Date 196 Permit No
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LLFee $CliU
oAppcation
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 ac cc with the provisions of the Plumbing Code of the City of
a w Cupertino, and all then la 's applicable t e ti
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�,a Use of Premise
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PLUMBING INSPECTOR cam—,
—FIXTURES
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories 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 . Sink & Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals 11 Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee p
7-prinkler Valves Water Sys. Fee
Per Fee
TOTAL TOTAL FEE
RE ORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final