2719 LOT NO. J77
tPPLICATIO FOR_PLUMBING PERMIT
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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.
LL Use of Premises
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PLUMBING
INSPECTOR
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PIX R . IN E MAI DRAIN
UNITS FC ES UNITS FEES
'ame Heater Size
[Watei Clc;ets Materath Tubs To Curb
howers D To Prop. Lineavatories To Existing
itchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
'Washing Machines Size
JUater Softeners Material
Bar Sinks To Main Drain
Comb. Sink,s Trays To Curb
Dental Units _
Drinking Fountains —`
Moor Drains WATER SYSTEM 1
Hoppers Size / Ir U
Restaurant Sinks Material
San Traps O" AL FEES
UPground
ilFixture Fee
s Main Drain Pee
Waterers Storm Drain Fee
rvcs Water Sys. Fee Q
Permit Fee
TOTAL FEE
REVOR OF INSPECT N
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\Iain Drain