51009 (3) LOT NO.
NO. STREET V -
APPLICATION FOR PLUMBING PERMIT
`7 -OF CUPERTINO
r oL + Sanitary No.
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Application�� h�r�y gra t elCity�of Cupertino for a permit to install plumbing
o `a pipes and Z rr�xtures'hs ed q� �ie irever c side hereof, and agrees to install said prices
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all er aws apphc le ereto.
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.. Use of Prem es
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PLUMBING INSPECTOR
FIXTUREb NU, BER MAIN DRAIN
UNITS FEES UNITS1 FEES
Water Heave Size
Wate, Closets Material
bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
rill Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drin inns g Fountains
floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San raps TOTAL FEES
Urina s Fixture Fee
rea rains Main Drain Fee
WUt-ater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee 00
TOTAL TOTAL FEE Q
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final