100087 /�✓ / /�� I cJ!/ R / _O �//k! LOT NO.
NO. STREET
-"PLICA ON FOR PLUMBING PERMIT
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� a ® / TY OF CIIPERTINO
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' 0 Sanitary No.
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3 < Ua 1196 Permit No. / 00
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0 o P LSI lcaAFixsI gr��dq`(he City of Cupertino for a permit to install plumbing
w a 1 sad ii IM l r I 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
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Cupertino, and all other laws applicable thereto.
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�. Use of Premises Q.2,
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oState License �z '�9 Z Approved
0 ` PLUMBING INSPECT
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
WXOas'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Har Sinks To Main Drain
Com . Sin s rays To Curb
Dental Units
Drinking Fountains
I ax Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
an raps TOTAL FEES
rinals Fixture Fee
rea rains Main Drain Fee
C-ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final