51187SnEETJ
f 'APPLICATION FOR PLUMBING PERMIT
AUGc" "f�'68 CITY OF CUPERTINO
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M o Sanitary No.
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o' Datr July - 1968 Permit No-r-/i�F 7
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Application is hereby made to the City of Cupertino for a permit to Install plumbing
`o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
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Dwelling
LL Use of Premises
00
3
OwnerDitz, Crane Company 2321,De La Cruz Boulevard
i JC�.,.,..,. ale-Sarat0 a Rd.
z By Palm Plumbing Co=wW 'r' ° g
O CONTRACTOR,AGENT
3 m Phone 21x.5"2323
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186579 WILLIAM D. BZN:Z'✓IGb
a State License. Approved
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
/
Size
Water Closet
.2—
Material
Bath Tub
To Curb
Shower
/
To Prop. Line ✓
Lavatories
02-
To Existin
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
TORM DRAINAGE
WashingMachine
Water Softener
jk%�[I!'at
Bar_Sink
ain Drain
Comb.Sink & Tray
urb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink-
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee Z 5-73f
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee Jf5%T