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�3'�P L�1G4T ym� OR PLUMBING PERMIT
a QI Y OF CUPERTINO
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x o _ / 65 Sanitary No.-
o a Date 19 Permit No `� n
LL CITY OF CUPERTINO Fee __
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
iand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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a w Cupertino, and all ier laws applica ke ereto.
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u�y PLUMBING INSPECTOR
FIS I URESNUMBER
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
bath Tubs To Curb
Showe:s To Prop. Line
Lavatories To Existing '
Kit,hen 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 s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
Son-ITT-raps TOTAL FEES
Urinals Fixture Fee -�
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler VaHcs Water Sys. Fee
.42 Permit Fee _
TOTAL TOTALFEE
R CORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final