100159 ��e_
LOT NO.
M1O. STRE F.I'
APPLICATION FOR PLUMBING PERMIT
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Y OP CUPERTINO
r o all ! Sanitary No.
Date �r - I 6� Permit No 4 a .
i LL Fee $ . 5
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O A lication is he b ad t the City of Cupertino for a permit to install plumbing
`o < pipe {�or®#toms ffiN' verse side hereof, and agrees to install said prices
i and o� Ixtures In accordance wi h e provisions of the Plumbing Code of the City of
a w Cupertino, and all of a 's applicable ler to.
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,I PLUMBING INSPECTOR
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FIXTURES OD
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 f 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 Fixture Fee
Area Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jpth,kler Valves Water Sys. Fee
Permit Fee .0
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Main Drain
Final