NO PERMIT NUMBER/!� 7 I LOT NO. l ��
NO. STREET
APPLICATIONBING PERMIT
iz < T P . I
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r -o R S:mi Ir Au.
0 a Dntr October , Q 4,96 2 1968 i It' No
U Fee $ A 3- S�
10
Application is herebym:rili'(A/th ty �e r f' a permit to install plumbing
`o pipes and/or fixtures hsted�iin` the re erse�FIMM,�an agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Q m Cupertino, and all other laws applicable thereto.
Dwelling
,. Use of Premises
00
> Ditz Crane Company W910 2Rdi De La Cruz Boulevard
3 Owner ress
oa
;,B, Palm Plumbing Company 1}eSunnyvale-Saratoga Rd.
O y CONTRACTOR, AGENT
3 Phone 245_23223
w z
a 186579 Approved WILLiA; i D. C NS=V1CH
o 2 State License /
PLUMBING INSPECTOR /
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water heater
Size
Water Closet
-1--
Material
Bath Tub
/
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
I/
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.SinkBTray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Train
Main Thain Fee )
Water Leader
Storm Drain Fee
Sprinkler Valve
I Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee a2 i rp