NO PERMIT NUMBER (2) 1 �12�/6JI�"H .d //GlWf'1 LOT NO.
No. EP.T 7
�y�,�t S
APEPLICATION FOR, PLUMBING PERMIT
z < CITY 0E1 CUPERTINO
Yo 6AUG 12 1968 . ` sanitary No.
Q 0
o j Date July 196 8 Permit No
uus]r1 f tF _" Pee $ :;2-3 .5?�
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto,
Use of Premises Dwelling
J
0 0 0
2295 De La Crus Boulevard
3 ne C
Owner Dits Craompany Address
o <
Z� B Palm Plumbing Company 12.11L Sunnyvale-Saratoga Road
J O y CONTRACTOR, AGENT
3 << Phone 2'2323
w WILLIAM D. BENEvicA
f State License 1;86579 _ Approved
< o
—U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
_ UNITS FEES UNITS FEES
Water heater / Size
Water Closet Material
Bath Tub / To Curb
Shower / '['o Prop. Line ✓
Lavatories To Existin
Kitchen §ink / Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine / Size
Water Softener Material
Bar Sink To Main Drain
Comb.SinkR'1'ray To Curb
Dental Unit
Ihinkin fountain
Floor Drain WATER SYS'T'EM
Hopper Si ze
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Thain Fee
Water Leader Storm Thain Fee
Sprinkler Valve I Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total ,� 'Total Fee a�j f