NO PERMIT NUMBER No. Street Lot No. ,.?d
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aAPPLICATION EOR PL�F9BING P.�Rty�17'
E CITY 61111
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OC T 31
1Sanitary NoJJ l�,
Date Dotober 28, 1968 1968 q'emtPit No.
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Application is hereby made to the City o Cupertino#on arpErthS�rto Install plumbing pipes
and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
"e laws applicable thereto.
J
o Dwelling
A Use of Premises
Owner Ditz Crane Company �5 De La Cruz Boulevard
y ress
Palm Plumbing Company 12311 Sunnyvale-Saratoga Rd.
By Address
3 245-2323ctor,Agent
v ° Phone
186579 WILLWA D. E=NEV11-..
-- �/ State License Approved
(" Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees I Units Fees
Water Heater Size
Water Closet %3 Material
Bath Tub / To Curb
Shower To Prot). Line v
Lavatories I To Existing
Kitchen Sink 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 Crn
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee c/
Vac Breaker
Skimmer
Filter
Permit Fee
Total V1 YOVl Total Fee