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TII PLICATI� l�R PLUMBING PERMIT
tt S CUPERTINO
Date uV -e Permit
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� Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
yo
Owner Z • /�
By�tONTRACTOR, AGENT
Phone — C -O -d
Address �+
Address -5rQ • "6�x '4:�`,
Approved WiLLIAM, D. �.. •JIG:i
PLUMBING INSPECTOR
' FIXTURES I NUMBER I MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater I Size
Size I I
Water Closets Material
Material
Bath Tubs To Curb
To Main Drain
Showers To Prop. Line
To Curb
Lavatories To Existing
Fixture Fee I
Kitchen Sinks Not Coon.
I Main Drain Fee
Dish Washers II
Storm Drain Fee
Waste Disposals
I Water Sys. Fee I
W' h T STORM DRAINAGE
Permit Fee
as rays
Washing Machines I
Size I I
Water Softeners
Material
Bar Sinks
To Main Drain
Comb. Sink & Traysl
To Curb
Dental Units
Drinking Fountainsl I II I
Floor Drains i II
WATER SYSTEM
Hoppers ---
Size _
Restaurant Sinks 14V
Material
Sand Traps II
TOTAL FEES
Urinals/ f rA II
Fixture Fee I
Area Drains P
I Main Drain Fee
Water Leaders I ' �� ��
Storm Drain Fee
Sprinkler Vanes
I Water Sys. Fee I
Permit Fee
TOTAL
TOTAL FEE
RECORD OF INSPECTION