NO PERMIT NUMBER (3) � No. StreetrX Lot No.
o —
y
a
APPL, A I9 PZ B IT
fi �V
C�7�SaC�N ��
U
CCT 31. 1968 S [tory No.
Y Dale October 29, 196_ Perrnit No.
3 CITY OF CUPERTINO Fee 5 2G, s�
s Application is hereby made to the 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 and/or fixtures
o ; in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
c laws applicable thereto.
n �
Dwelling
„ A Use of Premises 99pp[[
o U Mg
' Owner Dita Crane Co. 5 De La Cruz Boulevard
O �
° By Pala Plumbing Co. dd:�ss&mnyvale-Saratoga Rd.
3 tom. Contractor,Agent
v o Phone
245-2323
186579
State License _1,Approved I
^I y- \ Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size 77-
-Water Closet Material
Bath Tub / To Curb
Shower To Pro . Line v
Lavatories - To Existin
Kitchen Sink Not Conn.
Dish Washer
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 UMaterialSand Tra FEES
Urinal Area Drain eWater Leader eeSprinkler System e /.
Relief Valve 11 Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee a2.GL
Total Total Fee