NO PERMIT NUMBERLOT NO. W
NO. STREET
ADPL=ICA'ONTFOR PLUMBING PERMIT
��
CITY tOF CUPERTINO
1fAUU U 1968 _' Sanitary No.
Date d111`V 196 8 Permit No
017 UElpFDTV10 Fee$ Z6,6
Application'is heeeby 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
Palm Plwabing Company
CONTRACTOR,AGENT
Phon 245-2323
State License 186579
2295 De La Cruz Boulevard
Address
1A2� Sunrryvale-Saratoga Road
ess
WILLIAM D. SENEVIC.•i
Approved
PLUMBING INSPECTOR
FIXTURES I NUMBER MAIN DRAIN
UNITS I FEES 11 UNITS I PFRC
Water Closet � Material j
Bath Tub / '1'o Curb
Shower /I H To Pron. Line t/
Not Conn.
Dish Washer
Waste Dispo
Machine
Comb.Sink&Tray I I , 11 To Curb
Drinkin Fountain
Floor Drain WATER SYS'T'EM
Hopper Size
Urinal
Water
Valve
TOTAL
Permit Fee
Total Fee
ee