100092 (2) » L-4� ' LOT NO.
NO. SnEF.T
N ADPL C TION FOR PLUMBING PERMIT
.� OF CUPERTINO
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r o Sanitary iA'o.
KLL t6 0 0 9
° ' Date I Permit No
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i 4 Fee .$ y
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o,'J►J� he City of Cupertino for a permit to install plumbing
Oa pipes and/or Iixturc� lr•.verse side hereof, and agrees to install said prices
r 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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CONTRACTOR AGENT VYT- -qc
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as State Licens �� Approved /
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PLUMBING INSPECTOR
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
`X,net 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
aih Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink & Trays To Curb
Dental Units
Drin ing Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Sand raps TOTAL FEES
renals Fixture Fee
rea rains Main Drain Fee
Water Leaders Storm Drain Fee
Jpr(nkler Valves Water Sys. Fee , ro
00 Permit Fee ,pJ
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final