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APPLICATION FOR PLUMBING PERMIT
AUG S 1568CITcY OF CUPP.RTINO
Sanitary No.
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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 Duelling
OwnerDitz Crane Company 2Ayd De La Cruz Boulevard
B Palm Plumbing Company lRAe§unnyvale-Saratoga Road
By CONTRACTOR,AGENT
Phone 215-2323
W{LLIAM D. BEDIEVICH
State License 186579 Approved
\( PLUMBING INSPECTOR
FIXTURES I NUMBER I MAIN DRAIN
UNITS I FEES UNITSF'FES
Water Closet
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
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&'Cray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee