51087 (2) LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
0 C OP CUPERTINO
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r o i Sanitary No. p
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0 a Uate R 1 „196 Permit No
w LL b Pee $
To p3n,
r ApplicatoQ`tuyb••e((�'' o the City of Cupertino for a Permit to install Plumbing
o 1 pipes and/or f,xturcYlist Q�side hereof, and agrees to install said prices
i and/or fixtures in accordance wi t N6,isions of the Plumbing Code of the City of
a w Cupertino, and all ode{ laws appli le ereto.
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�. Use of Premises
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ZJ /z Address
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° o Ste Lice t: Approve
U PLUMBING INSPECTOR
Illx I URES
UNITS FEES UNITS FEES
`.Cater Hcatc Size
Water Closets Material
Bath Ttrbs 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 m Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee 11.7
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinklcr Vnlves Water Sys. Fee ,Q
Permit Fee D D
TOTAL TOTAL FEE D Q
R CORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final