NO PERMIT NUMBER (3) NO. STREET T T--� LOT NO.
APPLICATI LUMB0 PERMIT
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z f o ry No.
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O aDate �a 19)668Lrmit No
3LL Pees -2 J.
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Application is here�t e a � v ��t for a permit to install plumbing
o pipes and/or fixtures Ii llyc n re%x42F E}r��, 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.- - - - -
w x
� w Use of Premises
Dwelling
00
3 Owner D1tz Crane Compal e,�e La Cruz Boulevard
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a_j 321h
z ny Palm Plumbing Cozr W � ess
3 CONTRACTOR, AGENT
- � Phone 2(�j_2323
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s State License-186579 Approved WILLIAM D• D�=' �s' 'G"
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W
_U y PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNI"S FEES
Water Heater Size
Water Closet Material
Bath Tub / To Curb
Shower / To Prop. Line "
Lavatories 02 To Existing
Kitchen ink / 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 TO'T'AL 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
Total Total Fee ;j