NO PERMIT NUMBER (2) No_� '� Street j� Lot No.�f�3
�7 --.� 'Ind
1 APPLICATION FOR PLUMBING PERMIT
e �N0V 19 1968 CITY OF CUPERTINO
O
Sanitary No.
Novemb4l-K
Datif l� 8
196_
E e t t ! Permit No.
Y
3 Fee
r 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
in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
"e laws applicable thereto.
Dwelling
e Use of Premises
o Ditz Grane Uompany 2295 De La Cruz Boulevard
O Owner Address
y By Palm Plumbing Company SSSunnyvale-Saratoga Rd.
3 Z Contractor.Agent
0 245-2323
d Phone
a 186579
State License AppweaNILLIAIA D. F3cNEVl�a
d✓I Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units. Fees
Water Heater / Size
Water Closet Material
Bath Tub / To Curb
Shower To Prop. Line
Lavatories _ To Existing
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 Material
Sand Trap TOTAL FEES
Urinal Fixture Fee / J
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee ,
Relief Valve. 11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total / Total Fee J