51187/ % / I LOT NO.
NO. AS SWE F.St�
ACM ON',,F,OR PLUMBING PERMIT
"D
I YIOP CUPERTINO
fMAY 31 1968 DI sanitary No.
Date /� May 23 196 8 Permit No r�/"�7
r7y l r. �ii�� �T��t�� Fee $ e — , .ice
Application is hereby made to the City of Cupertino 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 accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Dwelling
Owner Ditz Crane Company
n_ Palm Plumbing Company
2295 De La Cruz Blvd.
Address
A ren
134s Sunnyvale -Saratoga Rd.
CONTRACTOR, AGENT
Phone
245-2323
'
WILLIAM D. 6G
State License 186579 Approved NEVICI-I
x PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size ell
Water Closet
l3
Material E /,
Bath Tub
i
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
Size
Water Softener
Material
-Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
I 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 Valve
Water Sys. Fee j' O
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ..?f -O
Total
// G
Total Fee o?G6a