51167 (3)NO. STtEET
PLICATION FOR PLUMBING PERMIT
z s ® e ITY OP CUPERTINO
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at�n-is�{ r I City of Cupertino for a Permit to install Plumbing
`o pis a dvrrfixt4th c;l� revers, side hereof, and agrees to install said prices
> 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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Use of Premises Alle 6;1�r
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PLUMBING INSPECTOR
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
,"power
To Prop. Line
Lavatories
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Ilopper
Si ze
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water S s. Fee /
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Permit Fee
Total � Total Fee �,y"o