51123 /O�ZI P30(e C� • LOT NO.
NO. STREET'
CT O OR PLUMBING PERMIT
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° Apg1Xt ton li rherc4�P�iaFk4bkt$ -ity of Cupertino for a permitto install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r I 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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4 Use of Premises 71-e
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a o State License Approved
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PLUMBING INSPECTOR
FIX R .
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
Was' Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink a Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
rea Drains Main Drain Fee
Water Leaders Storm Drain Fee
Jprinklar Volvos Water Sys. Fee
Permit Fee AA"
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final - �(