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�� APPLICATION FOR PLUMBING PERMIT
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JAN 1 196J IT0r CUPF.RTINO
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Application is hereby made to the City, of Cupertino for a permit In install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
ww Cupertino, and all tic laws applic Iceretoc'.
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— U PLUMBING INSPECTOR /
PIX I URES
UNITS FEES UNITS FEES
Water Heate Size
Woter 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 j Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s 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
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Water Leaders Storm Drain Fee
Sprinkler valves Water Sys. Fee
Permit ee F 17
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Main Drain
Final