NO PERMIT NUMBER (3) No. Strect� Lot No.,,,:,
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a AP CA'fCON®FOR,BLU�FMBIJJG PERMIT
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CITY OF`Cl7'PERT
f(OCT 3-L 1968 Sanitary No.
Y Date October 29lArr. 168 Permit No.
CUPER
° Fee SeZ �i , S�
3
s Application is hereby made to the City of Cupert��O f6r a permit to 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
c2 laws applicable thereto.
° Dwelling
A 0 Use of Premises
°
o 0 ?�Owner Dita Crane Co. AS Do La Crag Boulevard
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O
N By Palm Plumbing Companly M34sg9unnyvale-Saratoga Rd.
3 Contractor,Agent
d ° Phone 245-2323
185579 1�`d`cH
[f State License Approv�WILLIAM D•
Nom•Plumbing Inspector j
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size
Water Closet Material
Bath Tub / To Curb
Shower To Prop. Line d
Lavatories 3 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 latt
Sand TrapFEES
Urinal AL 5V
Area Drain e ��Water LeadereeSprinkler System
Relief Valve 11 Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee (�-�
Total / Total Fee