51187 (2)O. LOT NO.
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�APPLICATION;IFOR PLUMBING PERMIT
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March 29, 1968 7
Date — 196_ Permit No 3`//
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Pee$ o26,S0
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 DitrZ_.Crane On- Address 9905 ilnl.. r....,, ni..a
B Palm Plumbing CO. Address 1234 N. Hwy 9
By CONTRACTOR. AGENT
Phone 245-2323
WILLIAM U. EiuVE'r'ICH
State License 166579 Approved
PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES 11 UNITSI FF.RS
Material
Shower
Kitchen ink 11 Not Conn.
Dish Washer Sewer Box
Waste Disposal 11 1
Wash Tray 11STORM DRAINAGE
WW
Material
Comb.Sink & Tray To Curb I
Dental Unit
WATER SY
Size
Material
'COT,
Fixture Fee
Main Drain I
Water Leader �1 Storm Drain Fee I
Sprinkler Valve Water Sys. Fee /,YD
tteltet Valve as Hee
Vac Breaker
Permit Fee
Total Fee