NO PERMIT NUMBER (3) r; No. Street Lot No.o2/
o —
a APPLICATION WRYLUMBING PERMIT
E T .;ORO U P-fft O
y n
ar y No.
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Y Date October 28, , ,0�T 31 1968 I �� Permit No.
30 Fee Sot , S�
Application is hereby maditoltTTlhc (l'•itty ofCuperfha•forp�a ptermit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,'and agreesltoinstall said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
a'c laws applicable thereto.
v
° Dwelling
ro A Use of Premises
02295 De La Cruz Boulevard
° Owner DitZ Crane Co, Address
o
By Palm Plumbing Company Mgk Sumrjvale-Saratoga Rd.
3 s°. Contractor,Agent
° Phone 2115-2323
186579
— State License Approved' r�
X Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees I Units Fees
Water Heater / I Size
Water Closet 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 I 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 Storm Drain Fee
Sprinkler System Water Sys.Fee
11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee cl
Total / Total Fee ;,7 //