51187LOT NO.�/D-j
APPLIC=ATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Yo APR n1968 � Sanitary No.
o < Dat{ --Mazy 29 1968 .� //,p %
� 196— Permit No
Fee$
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� 'Application is hereby made to the City of Cupertino for a permit to install plumbing
o r 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
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises Di78lh
00
3 Owner Ditz Crane Co. Address 2295 Dela Cruz Blvd -
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z By Palm Plumb l-T>g Co. Address 1234 N. Hwy 9
O CONTRACTOR, AGENT
3a
Phone 245-2323
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State License 186579 Approved
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— U .PLUMBING INSPECTOR /
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Ileater
I Size -
Water Closet
-2-"
_
Material �.
Bath Tub
/
To Curb
$bower
/
To Prop. Line 4/
Lavatories
..-Z.
To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washin • Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink&Tray
To Curb
Dental Unit
Drin king Fountain
Floor Thain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Thain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water S s. Fee lls-el
Relief Valve
Gas Fee /
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Gl <9.J'D
Total Fee