51167.2W Q
W
LOT
NO. STREET
r 44P1 KII NI�FOR PLUMBING PERMIT
Cl Vi%F CUPERTINO
(MAAY6131968 kJ
Sanitary
196 8
—
No.
Permit No �5�// b % Y
r'{v 0!7
P �KU PIn Fee 02�a.Sa
Application Is hereby mad'etto 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
Owner Dit2 Crane Co,_ �essDe La Cruz Boulevard
By Palm Plumbing Co. WS{ - HWY 9
CONTRACTOR,AGENT
Phone 245-2323
State License 186579 Approved
PLUM73.{ INSPECTOR t
FIXTURES
NUMBER MAIN DRAIN
Bar Sink
UNITS FEES
Water IleaterSizeWater
To Curb
ClosetMaterialBath
![
MUNITSFEES
TubTo
Curb
Shower
To Prop. Line
Lavatories
i To Existing
Kitchen Sink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
TOTAL FEES
Wash Tra
STORM DRAINAGE
Washin¢Machine
/ Size
Water Softener
11 Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee .5-0
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
S rinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee o2Gi(�
Total
Total Fee
_22,�.