51039IDOJ LOT NO.
NO. STREET
FOR PLUMBING PERMIT
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("ITY OF CUPERTINO
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.57 !1' 1. Sanitary No.
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0 Date �L6*— Permit No
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Wo TV ,rl D Fee $ 2
0 Application is hereby- mad'e't"o the City of Cupertino for a permit to install plumbing
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0 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of -the City of
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< W Cupertino, and all other laws applicable thereto.
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< Use of Premises -j LL ch�
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3: Owner Address
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0 CONTRACTOR, AGENT
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2 State License`- Approved.
-0 PLUMBING INSPECTOR
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FIXTURES
NUMBER
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.
Dish Washers
Sewer Boxes
Waste Disposals
Wash Trays
STORM DRAINAGE
Washing Machines
Size
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Trays
To Curb
Dental Units
Drinking Fountains
Floor. Drains
WATER SYSTEM
Hoppers
Size
Restaurant Sinks
Material
Sand Traps
TOTAL FEES
Urinals
Fixture Fee
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Area Drains
Main Drain Fee
Water Leaders
Storm Drain Fee
Sprinkler Valves
Water Sys. Fee
Permit Fee
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TOTAL
TOTAL FEE ,_._ •����
RECORD OF INSPECTION
Underground Rough...
Partial Rough.-
Rough. Complete-.
Blain Drain
Final.-.