51167.2LOT NO
NO. /nEEI'
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
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xo sanitary No.
0 a /I�FJ �- c ) — 196 68 Permit No n6 • �-
U I Fee $ eX.�
2 LL // qq
� 0 AppliLtidnris%fi �tby ��jjadJ jlto the City of Cupertino for a permit to install plumbing
o �i _pipes and/or fixture hstcrd�.ilri the reverse side hereof, and agrees to install said prices
Z N.�;an9/orrfixtures in accordalice with the provisions of the Plumbing Code of the City of
_a ) Cupertino, C�j ,,tll- t7h-er laws-applicable-thereto. - - - - - -
0 LL Use of Premises � I ,IIID Ih-Telling
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3 Owner Ditz Crane Company
i � Palm Plumbing Company
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aG';V State
2295 De La Cruz Boulevard
12?4 Sunnyvale -Saratoga Rd.
Ad, ress
245-2323
CONTRACTOR,AGENT
rise J !186579 Approved /
PLUMBItv(', INSPECTOR 1 /
_FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNIT'S FEES
Water Heater
Size
Water Closet
Material e,
Bath Tub
To Curb
Shower
To Prop. Line
Lavatories
z
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINAGE
Washing Machine
J
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
Area Train
Main Train Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /
Relief Valve
Gas Fee
Filter
Total Fee