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� sT FOR PLUMBING PERMIT
OF CUPERTINO
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3 a Date /✓"ARs� 196 6 Permit No e0
_ CITY OF CUPERTINO Fee $ 4,00
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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
a . and/or fixtures in accordance with the provism of the Plumbing Code of the City, of
a w Cupertino, and r aws applicable the o.
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FIXTURES J
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Hath 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
Com . Sink s Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee'
Area rains Main Drain Fee
eater Leaders Storm Drain Fee
Jprinklcr Valves Water Sys. Fee
Permit Fee,
TOTAL TOTALFEE
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final