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LOT NO.
NO. 5 EF.I'
eN,C TION FOR PLUMBING PERMIT
OF CUPF.RTINO
Sanitary No.
196_ Permit No pa 2'6
Pee $
{I`icat f istllt eb jlc',tyj�to he City of Cupertino for a permit to install plumbing
'p q : ndjot fixte ' I fed 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
Cupertino, and all other laws applicable thereto.
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PLUMBING INSPECTOR
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FIXTURES
NUMBER MAIN DRAIN
Units Fees Units Fees
Water HeaterI
&V I Size
Water Closet
Materia
Bath Tub
To Curb
Shower
To ProD. Lin
Lavatories
41CM To Existing
Itchen Sink
Not Conn.
Dish Washer
Waste Disposal
Wash TraySTORM
DRAINAGE
WashingMachine
7) Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink &Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size "
Restaurant Sink
Sand TrapEES
Urinal
401,Area
Drain
nFixtureFee
eWater
Leader
eeSprinkler
System
Relief V-Iye
11 Caq Fee
Vac Breaker
Skimmer
Filter
Pool SveePL
Permit Fee
Total
Total Fee