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6L TION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
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LL wtl p tio Icreby made to the City of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1- 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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LL Use of Premises
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FIXTURES NUMBER
Units Fees
Water Heater lln
Water Closet
Bath Tub
Shower
Lavatorio
Dish Washer
Waste Disposal
Wash Tray
Washing Machine
Water Softener
Bar Sink
Comb.Sink & Tray
Dental Unit
Drinking Fountain
Floor Drain
Hopper
Restaurant Sink
Sand Trap
Urinal
Area Drain
Water eader
Sprinkler System
Refief Valve
Vac Breaker
Skimmer
Filter
Pool Sweeper
MAIN DRAIN
Units Fees
Size
Material
To Curb
To Pro . Line
To Existine
Not Conn.
STORM DRAINAGE
Size
Material
To Main Drain
To Curb
WATER SYSTEM
Size`
Materia
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TOTAL FEES
Fixture Fee
Main Drain Fee o' -o
SI m Drain Fee
Water Sys. Fee
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