51001.2 (2) /0 rOO I b�•�..s a. 7�-iG�fl' ,fi LOT NO
NO. STREET
APPLICATION FOR PLUMBING PERMIT
NOF CUPERTINO
W ���O CCCC�'� Sanitar
C y No. -r0 < Date en 640 Permit No
3 mnit a�fo
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W n Fee $
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� Am � a ion is hereb made to the City of Cupertino for a permit to install plumbing
o '< pipe orCfi�eturs l � �!�{everse side hereof, and agrees to install said prices
and/or fixtures in accor'd�h�TalPth`the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
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Use of Premises
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O CONTRACTOR, AGENT
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ao State License-.;) 3-Q`3'3:(� Approved
PLUMBINGi SPECTOR ✓
/A �<
UNITS FEES UNITS FEES
IX/atnr Heate Size /
Water Closets Materia
Bath Tubs To Cur
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposal
as'h Trays STORM DRAINAGE
WMMachinesI Size
Water So teners Material
Bar Sinks To Main Drain
Comb. Sink x Trays To Curb
Dental Units A3
Drin ing Fountains
Moor Drains WATER.SYSTEM
Hoppers Size
Restaurant Sinks Material iie.41
San FFraps TOTAL FEES
rinals Fixture Fee 9, 's p
rea rains Maig, rain Fee j—oo
Water Leaders $4�in Fee „r-o
Sprinkler valves Water Sys. Fee J-V
1 11
Permit Fee o
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final._