51016.1 er/�Y� �-a�•V�'Y TJ�'�E LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
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w rc CITY OF CUF"cRTINO
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LLw IDPPA-atij)n hereby made to the City of Cupertino for n permit to install plumbing
0 a 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
a w Cupertino, and all other laws applicable thereto.
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PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size jyp
Water Closet IT Material G .+
Bath Tub To Curb
Shower To Prop. Line
Lavatories S� To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine ✓ Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size /" I 1'411—
Restaurant Sink Material host/,
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Re]6ef Valve 11 Gas Fe
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee