NO PERMIT NUMBER/U / / I �1.2�N//✓/ LOT NO.
NO. STREET'
APPLICATIO MPMBING PERMIT
" d IT li 1
Yany
❑ `' O.
o < Octo C -NS 1968
Date it No
3 a3�v
w LL Fee
t O
Application is hereb}' rt{adTIt ttfE it}}((gt;fl� q Ifpp((a permit to install plumbing
o pipes and/or fixtures listedlun the fevers�Isid d�rndd agrees to install said prices
> r 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.
wx Dwelling
a
Use of Premises
00
5 3 Owner Dita Crane Company s.�VIraiv-sazaboga Rd.
_j
z 1234 Sunnyvale -Saratoga Rd.
By Palm Plumbing Company Address
O CpNTRACTOR, AGENT
3P 245-2323
— m hone
w z
a 186579WILL:F.:S
a o State License Approved /
U I� PLUMBING INSPECTOR . /
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
.2—
Material
Bath Tub
/
To Curb
Shower
To Prop. Line v
Lavatories
To Existin
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
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Stom Drain Fee
Sprinkler Valve
Water Sys. Fee /
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �2
Total
'JV
Total Fee .2j%f D