NO PERMIT NUMBER o, No Lot No. ;rj' i
/6�Fina APPI)CRTION FOR PLUMBING PERMIT
E �_ llVOV 19 1968 V,'CITY OF CUPERTINO
0
v
Sanitary No.
( `1 Ny VeDlbl3r�-� K' 8
Date CPC 1 .. ��96_ Permit No.
° Fee S. C•
3
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 ro in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
Elaws applicable thereto.
° Dwelling
m ro Use of Premises
w Ditz Urane Uo,
2295 De La Cruz Boulevard
° Owner Address
o N
By Palm Plumbing CompagySSunnyvale-Saratoga Roa<
3 Contractor,Agent
° Phone 245-2323
3 /
��iV.S�f! WILLIAM D. BENEVICFI
State License Appro ed - -
1 � Plumbing Inspector
t
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material (✓
Bath Tub / To Curb
Shower To Prop. Line
Lavatories tp 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
Area Drain Main Drain Feer
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fee �1
Gwq Fee
Relief Valve
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee o2/