51167.3 Plumbing No.. reeR'-.% v Lot No.
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FOR PLUMBING
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0 ' .(NOV 19 968 APOCIACIOTY OF CUPERTINO PERMIT
v Sanitary No.
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E °DatV e �Qt1099TIN01968 Permit No.
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0 Fee Sot. J�
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
7 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'c laws applicable thereto.
o
ro 7; Use of Premises
Dwelling
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' Owner Ditz Crane Co. s e La Crus Boulevard
drs_ 1234 Sunrlgvale-Saratoga Rd.
By Palm Plumbing Company Address
3 -E Contractor,Agent
0 2115-2323
Phone
State License 186579 Appr/roveNILLIAM U. BENEVICH
Plumbing Inspector >.
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size
Water Closet t Material
Bath Tub To Curb
Shower / To Prop. Line t/
Lavatories To Existin
Kitchen ink 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 Z01
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee /G• 2
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee o2 Q�
Total otal Fee