LOT 29LOT NO.
NO. TRBEI
/d '6- _i.
4 AOPLICATIO.N�FOIR PLUMBING PERMIT
w CITY,- iOF CUPERTINO
W' (AUG S 1968 Lu sanitary No.
X4
o J Date Julyr 1968 Permit No
3 a r!TV OF VUPCR 1 INN Fee $
To
� Application is hereby made to the Cit}' of Cupertino fora permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r . and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Ln
Cupertino, and all other laws applicable thereto.
—U
Use of Premises
Dwelling
Owner Ditz Crane Company
By Palm Plumbing Company
^. 245-2323 ACTOR, AGENT
State License 186579
Vy6,spe La Cruz Boulevard
12 31L Sunnyvale -Saratoga Road
AdaFess
Approved WILLIAM 0. 33\EVIG 1
�/ PLUMBING INSPECTOR
FIXTURES NUMBER I MAIN DRAIN
UNITS I FEES UNITS FEES
Shower I / 1 II TO Prop. Line I ✓ I
Kitchen ink /
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
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee C..S
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee (�
Vac Breaker
Skimmer
Filter
Permit Fee �Z�h
Total
Total Fee