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.
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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 >