51167.2-Plumbing ApplicationLOT
APPLICATION FOR PLUMBING
WY 6 1968 -CITY OF CUPERTINO
Sanitary No
PERMIT
HaTpsj''Id r2 n, 196 8 Permit No
ERTFI-ITFee $
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
Owner
By Palm Plumbing Co.
CONTRACTOR, AGENT
Phone�45-2323
State License 1865ag
A2A95sDe La Cruz Boulevard
res
AIA& N. Hwy 9
VJILLL:N7 D. U_—I'XVICH
PLUMBING INSPECTOR
MAIN DRAIN
UNITS FEES
UNITS FEES/
SizeMaterialTo
MFIXTURESNUMIBERNUMBER
Curb
i
To ProTo
Foci sting
Kitchen Sink
%
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
Size
Water Softener
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./
Area Drain
Main Drain Fee
Water Leader
Stonn Drain Fee
Sprinkler Valve
I Water s. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee