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PPLTION FOR PLUMBING PERMIT
< CITY OF CUPERTINO
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o{capon is hereby made to the City of Cupertino for a permit to install plumbing;
`o a pfp!eMnd/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 INSPECTOR
FIXTURES
INUMBER 11
MAIN DRAIN
Units I Fees 11
Units Fees
Water Heater
"V 11
Size
Water Closet
7
Material ,
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen
Not Conn.
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
I To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Materia
Sand Trap
TOTAL FEES
Urinal
Fixture Fee liV2�
Area Drain
Main Drain Fee '
Water Leader
-V
I Storm Drain Fee
Sprinkler System
11
Water Sys. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee . vy
Total
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Total Fee