51161a.2fZGk
NO. I STREET
m %APP, LI_CATION
,���RP
ITY
fl� P1! �F 6 ,
CITY OF CUPERTImn
Application is hereby made,to the
1 _ pipes and/or fixtures listed on the r
�) and/or fixtures in accordance with t
Cupertino, and all other laws appli
Use of Premises-�� 62
LOT
FOR PLUMBING PERMIT
OF CUPERTINO
1$rr Permit No.
00
Fee $_
City of Cupertino for a permit to install plumbing
everse side hereof, and agrees to install said prices
he provisions of the Plumbing Code of the City of
able thereto.
Address IAI='u
Approved
NG INSPECTOR
11M URES
NUMBER 11
MAIN DRAIN
UNITS FEES
IUNITS I FEES
Water Heater I
pZ ,%-
Size J-00
Water Closets
3,OO�
j Material
Bath Tubs
Id.o0I1
To Curb I I
Showers
OU
To Prop. Line,
Lavatories
,oal
To Existing
Kitchen Sinks
7.,o0jj
Not Conn. I I
Dish Washers
II
Waste Disposals
II
Wash Trays
II
STORM DRAINAGE
Washing Machines Ia.06
Size
Water Softeners
Material
Bar Sinks
To Main Drain l
Comb. Sink a Traysl
II
To Curb l
Dental Units
Drinking Fountainsl
III
Floor Drains I
1 II
_
WATER SYSTEM
Hoppers_l1
11
Size � /00
Restaurant Sinks
1 II
Material &,g V I
Sand Traps I
I I
TOTAL FEES
Urinals I
II
Fixture Fee I /S P
Area Drains
II
Main Drain Fee I 9. Or
Water Leaders
Storm Drain Fee I
Sprinkler Valves I
II
Water Sys. Fee
I�
Permit Fee a
TOTAL
TOTAL FEE
RECORD OF INSPECTION