51037 NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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0 < Date 196 Permit No
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Application is hereby made to the City of Cupertino for a permit to install plumbing
opipes and/or fixtures listed on the reverse 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 offer laws ap li lei
thereto.
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ao State Licen%VO -30 Approved
-0 PLUMBING INSPECTOR '
X I UREb _NUIN BER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heate Size
Water Closets Material
Bath 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 (/0 Size
Water Softeners77— Material
Bar Sinks To Main Drain
Com . Sinks Trays To Curb
Dental Units
Drinking Fountains
Floor Drains WATER SYSTEM
Hoppers Size
Restaurant Sinks Material
San Traps TOTAL FEES
Urinals Fixture Fee ^
Area Drains Main Drain Fee
Vater Leaders Storm Drain Fee
Sprinkler Valves Water Sys. Fee
Permit Fee L
TOTAL TOTAL FEE
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
'lain Drain
Final...