NO PERMIT NUMBER (3) NZ/1 LOT NO. y/ /
NO. a EE.T
S1�Qt1!"''E�O LUMBING PERMIT
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z o SEP sa Sanitary No.
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0 Q Date 9 196 8 Permit No
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Pee $ 117-1�. S__6sLLoApplicaApplication 1ebl odelftjgNWpertmo for a
permit to install plumbing
`o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto
Use of Premises Duelling
00 99� T1
50 Owner Ditz Crane Company 2299 e La Cruz Boulevard
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z By Palm Plumbing Co m?� '�+esS �ale.Saratogaoa
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O CONTRACTOR, AGENT
3 < 215-2323
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aState License 18657.9 App/roved
r�— 0 `y PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS BEES
Water Heater / Size _
Water Closet Material
Bath Tub / To Curb
Shower / To
Prop. Line
Lavatories To Existing
Kitchen $ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORN] DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.SinkRTray 'Co Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYS'T'EM
Hopper Size
Restaurant Sink Material
Sand Trap 'TO'T'AL, FEES
Urinal Fixture Fee
Area Drain Main Drain I'cc
Water Leader Slom Drain Fee
Sprinkler Valve Water Sys. Fec
Relief Valve Gas- Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee oZ(iS�