51118 LOT NO.
FAN
YAPPLICATI +ICOR PLUMBING PERMIT
wE 25 lybb
Z C v OF CUPERTINO
x o sanitary No
0 a Date Q6t7 &En T tNQU Permit No S///u
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0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o w pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and al of is laws applica c reto.
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a Use of Pre ises
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af state License / 430 Approved
J PLUMBING INSPECTOR
i
HX-1 URES
UNITS FEES UNITS FEES
`.Curer 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 ,Trays To Curb
Dental Units
Drinking Fountains
T-Ioor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand Traps TOTAL FEES
Urinals Fixture Fee
Area DrainsMain Drain Fee
Water Leaders Storm Drain Fee
Sprinklerl
Vales Water Sys. Fee , Q
Permit Fee , J
TOTAL I TOTAL FEE Q
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Nlain Drain
Final