51167.2I/
_I
� No. Street Lot Na.
o
n
d APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
0
H,Sanitary No.
E Date , 196,L% Permit No. f&6 2-A
0
r Application is hereby made to the GityLof Cupertino'for a permit to install plumbing pipes
-- and/or -fixtures -listed on the -reverse side hereof, andagreesto installsaidprices and/or fixtures -
0 in accordance with the provisions of the Plumbing Code ofthe•City of Cupertino, and all other
'c laws applicable thereto. 'V
iO
12
m A Use of Premises
Dwelling
Ditz Crane Company 2295 De La Cruz Boulevard
0 Owner Address
o
By Palm Plumbing Company ?,�AaSunnyvale-Saratoga Rd.
3 Contractor, Agent
" ° Phone 245-2323
^a'/ 186579
T State License/ Approved
•/ Plumbing Inspector
FIXTURES
NUMBER
MAIN DRAIN
Units Fees
Units Fees
Water Heater
Size
Water Closet
Material )
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
.J--
To Existing
Kitchen in
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
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler System
Water Sys. Fee /
Relief Valve
11 Gm Fee
Vac Breaker
Skimmer
Filter
Permit Fee s2--
Total
Total Fee a;j