NO PERMIT NUMBER (3) LOT NO.
NO. STftET
APPLICATION FOR)PLUMBING PERMIT
" i IT.Y OL? CUPERTINO
w IAUG 12 t% �_
r o Sanitary N0.
p 4
o a Date Ju4Y 196/ 8 nn Permit No
3v �? \� lr � �i�r_i\� ir'V Fee $ x6 ,,5--6
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To
4 w Application is hereby made to the City of Cupertino For a permit to install plumbing
0 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 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.- - — - - - - -
Dwelling
Use of Premises
00
3 Owner Ditz Crane Cotpp� R??gSyDe La Crus Boulevard
J J Palm Plumbing Co 12 4 Sunnyvale-saratoga Rd.
J , By mPa�lY Ad cess
3 Q CONTRACTOR, AGENT
- Phone 245-2323
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6579 WILLIAM D. BENEVICH
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ao State License Approved
-U PLUMBING INSPECTOR LX
11, x
FIXTURES I NUMBER MAIN DRAIN
UNITSI FEES 11 UNITS FEES
Water heater / Size
'Water Closet Material
Bath Tub / To Curb
Shower / To Prop. Line
Lavatories To Existing
Kitchen Sink / Not Conn.
Dish Washer Sewer Box
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 Valve Water Sys.Fee /
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee oZ
Total z{ Total Fee a? S v