51039 / D ( V LOT NO,
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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o < r'-�ppl ,(ion is hereby made to the City of Cupertino for a permit to install plumbing
i a r `�'(i(t}fp{!•tr{'tsted on the reverse side hereof, and agrees to install said rices
> < and/or fixture a .•ith the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises P 11
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3 Owner t',v./ Address
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a o State License Approve
—0 `\ PLUMBING INSPECTOR
FIX-1 URES
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 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 raps TOTAL FEES
Urinals Fixture Fee
yA��r�ea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee D D
Permit Fee ?00
TOTAL TOTALFEE
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final....