51167.2 (2)LOT No.
NO. STREEI'
p EBF INS FOR PLUMBING PERMIT
1 ITY OF CUPERTINO
MAY 6 1968 11 J Sanitary No.
Date May 2x 19(8— Permit No SZZl& 7 Z
I ,
(s+TlC +'a�l�`DTIf((� Fee Ea.��S�
,1
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 Company � d9De La Cruz Boulevard
r r ss
By Palm Plumbing Company AWk,N. Hwy 9
CONTRACTOR, AGENT
Phone.245'2323
-
State License 1.86579 Approved '
PLUMBING INSPECTOR , /
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
er Box
Waste Disposal
Wash TraySTORM
DRAINAGE
WashingMachine
ji%
Water Softener
Material
Bar Sink
Main Drain
Comb.Sink & Tray
Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee r
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee r.�