NO PERMIT NUMBERN
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APPLICATIONFOR PLUMBING PERMIT
CITY11; CUPERTINO
a 1968 i�
Sanitary No.
Date --- — Jul -7.- 19681 �G (0Permit 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 Dwelling
Ditz Crane C 2295 De La Cruz Boulevard
Owner �P�3' Address
B Palm Plumbing Company 7A2d*s&luruu vale -Saratoga Road
By CONTRACTOR, AGENT
n 245-2323
State License
186579 Approved WILLIAM D. BENEVICH
PLUMBING INSPECTOR ✓
FIXTURES I NUMBER 11 MAIN DRAIN
Shower I / I I To Prnn. Line I Li I
Kitchen $ink / Not Conn.
Dish
,her
Sewer Box
Waste Disposal
Wash 'fray' �I S'T'ORM DRAINAGE I
Washing Machine / Size
Com
b.Sink & Tray To Curb I
Dental Unit
Floor Drain WATER SYSTEM
Hopper Size I
TOTAL FEES
Water Leader I 1 11 Storm Drain Fee I
Relief Valve
Vac Breaker
Permit Fee
Total Total Fee oj(��D
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