51167.2e.
M/MMA
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APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
p Sanitary No.
Date11IlE 196 8 Permit No
JUL31 196p t Fee 5a�
Application i
ation s hereby itlade t!��he City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and.agrees to install said prices
andVEr/ fdres imaecgrdance with the provisions of the Plumbing Code of the City of
Cupertioo,l"snd alliotherr+laa ls3 applicable thereto.
- - — - -
— it �v
Use of Premises Dwelling
Ditz Crane Company
J By Palm Plumbing Cornnzgy
O CONTRACTOR, AGENT
3Q 245-2323
— m Phone
wZ
17
f IV State License 186579
A2A95 De La Cruz Boulevard
ress
Al sSunnyvale-Saratoga Rd,
Approved
PLUMBING INSPEC.OR /
FIXTURES I NUMBER �� MAIN DRAIN
UNITS FEES UNITS I PEES
al
Shower
Kitchen ink / Not Conn. I
llish Washer Sewer Box
Waste Disposal
101111 119FAT"d
Material
Comb.Sink&Tray I 1 II To Curb I I
Fountain
Floor Drain WATER SYSTEM
}Topper � Size I
TDTA
e Fee
Main
Skimmer
Filter
Permit Fee o2 0-0
Total / Total Fee aGS