NO PERMIT NUMBER No. Street T� Lot No n?—d
0
APPLICATION,FOR liil3MBIN PERMIT
E CITY
QjFI-', RT N
o v fn
° �(,'T Sanitary 0. i
y Date October 28, , 198_ 1968 lV Permit No.
°
CITY S..
3 nr �It
Application is hereby made to the'CiCy of+Cupertiro.� rF permiNto install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agiee. to5nGfi id prices and/or fixtures
`o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
Alaws applicable thereto.
0
°=
Dwelling
w n Use of Premises
0 22 De La Cruz Boulevard
Owner Dit2 CranB COmpagp Address
ti By Palm Plumbing Company Aa Ad Rd.
3 .5 ox'3 ctor,Agent
2- 3
W ° Phone
n
166579 �..,. _ . .. . •_.__ .''..I
State License pprove&�
Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet -2- Material
Bath Tub To Curb
Shower To Prop.Line ✓
Lavatories 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 UMaterialSand Tra FEES
Urinal Area Drain eWater Leader eeSprinkler System e
Relief Valve I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Z Total Fee .�