100069 (2) 04
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APPLIICCATI FOR PLUMBING PERMIT
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O Application is hereby made to the City of Cupertino for a permit toinstall plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
> and/or fixtures in accordance with the provisions g.4 the Plumbing Code of the City f
a w Cupertino, and ae lases applicable thereto
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PLUMBING I CI
1
FIAI
UNITS FEES Mb
rN
vRq
UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
ash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s rays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
SanTTraps TOTAL FEES
Urinals Fixture Fee
rea rains Main Drain Fee OQ
Water Leaders Storm Drain Fee
7-p7nklcr Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE Op
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final