51187LOT NO.
APPLICATION FOR PLUMBING PERMIT
fAPR << u8CITY Of CUPRRTINO
banitary No.
Date n•MarCh,.29.?-1968 _ „196— Permit No S// c� 7
a...... � .. Pee 5 3,.5"y
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 Ines applicable thereto.
Use of Premises Dwelling
Ditz Crane Co.
Address 2295 De La Cruz Blvd.
By Palm Plumbing Co. Address 123h N_ Hlay 9
CONTRACI'OR,AGENT
Phone 2)15-9393
Spate License 186579 Approved WiL`UVYI D. BENEVIIC14
PLUMBING INSPECTOR
I K
FIXTURES I NUI1BFR MAIN• DRAIN
UNITS1 FEES 11 UNITS I FEES
ShowerTo
Pro .Line �/
Lavatories
To Existin
Kitchen 5ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Hain Drain
Comb.Sink &'fray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Vac
PWore Pee
Main Drain Fee
Storm Drain Fee
Water Sys. Fee
Gas Fee
Permit Fee
Total Fee