NO PERMIT NUMBERN Q
w
LOT NO. A/"
NO. k STREET
APPLICATION FOR PLUMBING PERMIT
CITY -OF CUPR(T\I`NO f�
.E
[)ate October 1968_i J,T i lJI011nnit No
iFee $ oZ(o.j�
Application is hereby made to the -City gft,Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverseside herer;fl arida agreels 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 W� De La Cruz Boulevard
By, Palm Plumbing Company
CONTRACTOR, AGENT
Phone 215-2323
State License 186579
]A2X,,% n yvale-Saraboga Rd.
Approved
X PLUMBING INSPECTOR
FIXTURES I NUMDER 11 MAIN DRAIN
UNITS1 FEES 11 UNITS I PEES
Water Closet
%
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line
Lavatories
IWaterSys.Fee I
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
-7
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Ujnktn COuntaln
Floor Drain WATER SYSTEM
Hopper 11 Size
Urinal
Ptxtwe Pee
/ U
Area Drain
Main Thain Fee
AGO
Water Leader
Storm Drain Fee
Sprinkler Valve
IWaterSys.Fee I
/O
Relief Valve
11 Gas Fee
Permit Fee
Total // G3 Total Fee In;