51145 (2) a -21- LOT N . �
NO. S EEE
ATION FOR PLUMBING PERMIT
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ti s ��ja��q�� FF t�p (�e City of Cupertino for a permit to install plumbing
`o pi / xttiretll"EWfj Hies reverse side hereof, and agrees to install said prices
r � an /or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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PLUMBING INSPECTOR
FIXTURES NU, BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath 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
Har 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
n k ler Valves Water Sys. Fee /'0--
Permit
o--Permit Fee
TO-TAL1 TOTAL FEE G d u
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.N'Tain Drain
Final