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NO PERMIT NUMBER (3) ❑ No.. re , Lot No._41' v M AP LIGATION FOR PLUMBING PERMIT E fNOV 19 1968 �� ' CITY OF CUPERTINO Sanitary No. E UbIa a CUtoU PMJITIN'O, 1968 Permit No. 3 Fee S ZQ �CS Z 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 12 laws applicable thereto. `�p V A n Use of Premises DNC^G� 1/ o U ' Owner Ditz Crane Co. i2d�5s De La Cruz B oulevard By Palm Plumbing Co. diressSun>�vale-Saratoga Rd. 3 s Contractor,Agent 0 245-2323 v Phone 186579 WILLIAM D. BENE IL;A State License Approved l t/ Plumbing Inspector 61< FIXTURES NUMBER MAIN DRAIN Units Fees Units Fees Water Heater Size Water Closet —t? Material Bath Tub / To Curb Shower / To Prop. Line ✓ Lavatories To Existing Kitchen Sink Not Conn. Dish Washer Waste Disposal Wash Tray STORM DRAINAGE WashingMachine rWATEmR Water Softener Bar Sink Drain Comb.Sink&Tray Dental Unit Drinking Fountain Floor Drain SYSTEMHo er Restaurant Sink Material Sand Trap TOTAL FEES Urinal Fixture Fee Area Drain Main Drain Fee Water Leader Storm Drain Fee Sprinkler System Water Sys. FeeRelief Valve Gas Fee Z / t Vac Breaker Skimmer Filter Permit Fee Total / % Total Fee >