51187yC )I �Z z �z-e/ LOT NO. &
�iNd f� y�\S ;F.F�
I ) 'APPL'ICATION FOR PLUMBING PERMIT
•' CITY OF CUPERTINO
APR �t 1968 E
Sanitary No.
March 29, 1966
Djtc. 196_ Permit No ,
t Y l I (1 rj tT!!�! ll Pee s o2 6. 3—D
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 Dit.7. Crane Co. Address 2295 De La Cruz Blvd.
By Palm Plumbing Co. Address 1234 N. Hwy 9
CONTRACTOR, AGENT
Phone -245-2323
State License 18 6.579 Approved WILLIAM D. Sr -NE ICK
PLUMBING INSPECTOR
Permit Fee
Total Fee
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
l
Size
Water Closet
17
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 &'fray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee rli
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 Fee