NO PERMIT NUMBER (2) N No. Street nN�FP3L�MBI
LotNo. �-ADPL}CA'I,' PERMIT
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Sanitary No.
October 28,CITY QT8 CUPERTINO
Y Date 196_ Permit No.
3 Fee S`2G• Is
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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
Dwelling
7 A Use of Premises
oODitz Crane Company H95 De La Cruz Boulevard
Owner ress
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By Palm Plumbing Company sSunnyvale-Saratoga Rd.
3 z Contractor,Agent
Phone 215-2323
3 �
�,,(/ State License 186579 -( Approved.^rzl I re.t n r77N!z'=V'
.t�/ Plumbing Inspector
FIXTURES INUMBER 11 MAIN DRAIN
Units Fees 11 Units 117ces
Water Heater Size
Water Closet C.3 Material
Bath Tub J To Curb
Shower To Proo. Line
Lavatories �' To Existing
Kitchen ink / Not Conn.
Dish Washer
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 S
Area Drain Main Drain Fee f
Water Leader Stom Drain Fee
Sprinkler System Water Sys. Fee
Relief Valve 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee -.P-1tV
Total / Total Fee