51118 IOS/6 RHmPARr A ✓E,
No. Street Lot No.
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APPLICATION FOR PLUMBING PERMIT
E �¢ ®ITY OF CUPERTINO
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Sanitary No.
Date 1C\ , 196_ Permit No.S Y
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° \�1,\V Fee $3 d�
App]ic �'is hereby m �i� C,ty of Cupertino for a permit to install plumbing pipes
and/or txtures list of erre side hereof,and agrees to install said prices and/or fixtures
° in accordance,wi�i ,e provisions of the Plumbing Code of the City of Cupertino,and all other
n'o laws appthereto.
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Use of Premises
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°, Owner ,k'1?R4 %AUDREY Hni5L-L1V1 Address /05/6 RAMPART
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_ By Address
3 Contractor,Agent
° Phone Z 56"— '53S3
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State License Approved WILLIAM D. BENEVIC}
d� Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pm. Line
Lavatories To Existin
Kitchen in Not Conn.
Dish Washer
Waste Dis osat
Wash Tra STORM DRAINAGE
Washin Machine 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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys, Fee
Relief Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �-
Total Total Fee