51143 — / LOT NO.
NO. STREET
® AMi PI I FOR PLUMBING PERMIT
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i at is �'�(� �j�Q the Cit of Cupertino fora permit to install plumbing
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reof, and arees to install sid price
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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FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Water Heat Size
Water Closet Material
Bath Tat To Curb
Shower To Prop. Line
Lavatories To F.xistin
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tmy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
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Permit Fee
Total Total Fee