51143 Lor NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
< CITY OF CUPERTINO
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a '�N aaa rr,AtN -� — I� Permit No.� //
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0 Op ca i hereby made to the City of Cupertino for a permit to install plumbing
o a Pipes�aiW r i. ores listed on the reverse side hereof, and agrees to install said prices
> an xtures i n nee with the provisions of the Plumbing Code of the City of
i upertino, and other laws aiielicable thereto.
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CONTRAC , AGENT
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ao State Licensee-tG-16(D7r5( Appro
PLUM BI I PECTOR
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FIXTURES NU,% BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
ish Washers Sewer Boxes
Waste Disposals
Wash Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink--, Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee
Waterrea rains Main Drain Fee
`dater Leaders Storm Drain Fee
oprink�rt valves Water Sys. Fee
Permit Fee
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .