51167.2a�0 9(O �k'� , A LOT NO.- �7/
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
w z
x o o. Sanitary No.
LL
0 j Dat J — _ 1968 Permit No ,5-116 7. oZ.
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ISI �I Pee$�c3
° -AppI ItionI it h� ,c madel-1tb the City of Cupertino for a permit to install plumbing
o r pipes and/or fixtures listed ori 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
Z w M'pertino�and�llilotherTVa%l Uapl'licable thereto. - - - - -
LL Use of Premises Dwelling u
pO Ditz Crane Company 225 De La Cruz Boulevard
O 3 Owner
Address
O<
Zj B Palm Plumbing Company ISSunny-vale-Saratoga
J O y CONTRACTOR, AGENT
3� 245-2323
Phone
aState License 185579 Approved
PWMN.G INSPECTOR
/J
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS I FEES
Water Closet I v2 I II Material Vl/, I
Shower I � I I To Prou. Line
Kitchen Sink /
Not Cann.
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
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee 3
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve I
I Gas Fee i.0-;??
Filter
Total Fee