NO PERMIT NUMBER (2) ZIL414
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d APP IGATION FOR PLUMBING PERMIT
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OV 19 1968L— 'CITY OF CUPERTINO
v Sanitary No.
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bate l;(N ,°!f b Tln.jl', 196 8 Permit No.
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° Fee �`• '�
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
° ro in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
a laws applicable thereto.
° Dwelling
A ro Use of Premises
° Ditz rano o, Dela Cruz Blvd.
° Owner Address
By Palm Plumbing Coo 12 4 Sunnyvale-Saratoga Rd,
Ad rens
3 y Contractor,Agent
° Phone p 2452323
n 3
186579 WILLIAM D. 13ENEVICH
State License I /pproved
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
Washinp Machine Size
Water Softener Material
Bar SinkTo 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 Fee
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief V�lve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �f
Total / ,r Total Fee / (�