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LOT NO.
NO. STREET
Am A I TION FOR PLUMBING PERMIT
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o ate 19G— Permit No
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� to the City of Cupertino For a permit to install plumbing
o < pipes /or fixtures listed on the reverse 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 w Cupertino, and all other laws applicable thereto.
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PLUMBING INSPECrOR
FIXTURES Jt
UNITS FEES UNITS FEES
Water Heate Size
Ware, Closets Material
Hath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers Sewer Boxes
Waste Disposals
XVas'h Trays STORM DRAINAGE
Washing Machines Size
Water Softeners Material
Bar Sinks To Main Drain
Com . Sink Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hopl?crsF //-0 Size
RestauranE Si6iks Material
San Traps /dM TOTAL FEES
Urinals Fixture Fee -0d3-
Area Drains L. Main Drain Fee
tVater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee /
eU Permit Fee ,2Je
TOTAL TOTAL FEE db
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final