51167.2NO.
LOT NO.
APPLICATION FOR PLUMBING PERMIT
wd _ CITY OF CUPERTINO
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30 a Date'�r��—-'jug 1960 Permit No//6%•a'
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4 b�JUL 311968 ��?; Fee
o Application is hereby made to -the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
z�.N aridJ/6 no Larne Fes inlli pe arc `vit li abh the le thereto. of the Plumbing Code of the City of
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Use of Premises Dwelling
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3 Owner Ditz Crane Company
z _j Palm Plumbing Company
J, By
O CONTRACTOR, -AGENT
3 m Phone 245-2323
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f P State License 186579
2295 Dela Cruz Boulevard
Address
384 Sunnyvale -Saratoga Road
ress
Approved
PLUMBING INSPECTOR ` t-1
` /
- -
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FFES
Water Heater
Size el I
Water Closet
t3
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen ink
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tra
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 FEFS
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 dBW
Total
Total Fee