51145 LOT NO, nJl /
NO. STREET
A-P.tLIGAt ON FOR PLUMBING PERMIT
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wIOF CUPERTINO
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o a Date IDEC 15 1, 6. Permit No, ,..2zz:'
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W w Fee $ 11,
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A 1 c oo he'�Q ga Q f City of Cupertino for a permit to install plumbing
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side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a Cupertino, and all other II ws a licuble thereto.
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Use of Prem
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3 O CONTRACTOR, AGENT
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ao State License 2 O yB Approved
U j PLUMBING INSPECTOR
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141XTURES J 13ER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heme /aO Size
Water Closets �j.� Material
Bath Tubs d To Curb
Showers ,oD To Prop. Line
Lavatories �? To Existing
Kitchen Sinks Not Conn.
Dish Washers / to Sewer Boxes
Waste Disposal
Wash Trays STORM DRAINAGE
Washing Machines / U Size
Water Softeners Material
Bar Sinks To Main Drain
Comb. Sink s Trays To Curb
Dental Units
Drinking Fountains
Moor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks MaterialCo-P
San Traps TOTAL FEES
Urinals I Fixture Fee ,
Area Drains Main Drain Fee
eater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee C
Permit Fee 0,t,
TOTAL TOTAL FEE /CIO
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final