100090 NO. STREET V
�.EP,�ICATION FOR PLUMBING PERMIT
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Grp rra OF CUPERTINO Sanitary No. 7!9o
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Date Permit No
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o io hcgJ� t t Cit}' of Cupertino for a permit to install plumbing
`o w pipe3'5hd'/oA turAaW(101p everse 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 1 law's apl icable t1pyto.
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LL Use of Prem
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-0 (� PLUMBING INSPECTOR
FIXTURES NUIN BER MAIN DRAIN
UNITS FEES UNrrS FEES
Water Heate Size
Water Closcts Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposa s
a;h Trays I ISTORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink ,& Trays To Curb
Dental Units
Drin ing Fountains
Floor Drains WATER SYSTEM
Hoppers ze
Restaurant Sinks Material
an raps TOTAL FEES
Urinals Fixture Fee
rea rainsMain Drain Fee
Water Leaders Storm Drain Fee
7-prinklcr Valves Water Sys. Fee
Permit Fee O
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final