NO PERMIT NUMBER (3) ay/J iZ J II/.�J.J LOT NO.
NO. STIkEEI'
APPLICATION FOR PLUMBING PERMIT
z z< CITY OF CUPERTINO
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s o ar No.
r October
O a Date I — % en it o
3 LLIOCT 14 1968 Tree s �G
o Application is hereby made to the City of Cupertino r=a-permit to install plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
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and/or fixtures in accordancf withf th ov(� [��t{+y 'rI bin Code of the Cit of
a w Cupertino, and all other laws'ip� licag'fthYY Ln I I�U g - y
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Use of Premises
0 0
Dwelling
O 0
, w 22 5 La Cruz Boulevard
0 3 Owner Ditz Crane COmpal$ A d'r'esss
oj B Palm Plumbing Co>palay JA2d�e53imr�yvale-Saratoga Rd.
J 0 y CONTRACTOR, AGENT
3 ` 215-2323
- m Phone
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a
a W ILLWi D. D_N V i—I
U State License Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater / Size
Water Closet Material
Bath Tub / To Curb
Shower / 1110 Prop. L,ine ✓
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&Wray To Curb
Dental Unit
Drinkin Fountain
Floor DrainWATER SYS'T'EM
Ilopper 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 I Gas Fee /
Vac Breaker
Skimmer
Filter
Permit Fee
Total / lGtYV Total Fee a6