NO PERMIT NUMBERm '7 I 1'�2�_ LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
J Sanitary 11'0.
h
Date OC'�Ob/ _it No
1 �CT s j� Pee $ �-3. J�
Application is hereby made to the ny% Co ertmo for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in RtmOriffith�thf Ons f the Plumbing Code of the City of
Cupertino, and all`oflier laws aplili�abl _h�±(j
Use of Premises
Owner Ditz Crane Company
Palm Plumbing Company
By CONTRACTOR,AGENT
245-2323
State License 186579
Dwelling
2295 De La Cruz Boulevard
Address
2234 Sunnyvale -Saratoga Rd.
Acl
r 6 :C4
VJ:LL::.17 D. L`.....
I--,' PLUMBING INSPECTOR , /
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FEES
Shower /
To Prop. Line i, -
Lavatories
Lavatories oL
To Existing
Kitchen 5ink /
Not Conn.
Dish Washer
Sewer Box
Waste Disuosal
TOTAL FEES
Machine
Material
Comb.SinkBTray i 1 11 To Curb
Floor Drain
WATER SYSTEM
Ilopper
Si ie
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader -
Storm Drain Fee
SprinkleValve
Water S's. Fee
Relief Valve
Gas Fee
Permit Fee
Total Fee