NO PERMIT NUMBER (3) No. Street Lot N11Z--1
APPLICATION'15 , LU�rM:G PERMIT
1 0
U 0.
San
Date w 29 T 31 1968
Ootob( 196 Permit No.-
-�3,IS-0
Fee S.
Application is he TtYcigFof OCURERTIA it to
reby made to" install plumbing pipes
and/or Fixtures listed on the reverse side hereof,and agrees to install mid prices and/or Fixtures
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto.
Dimlling
Use ot Premises
U
22 De La Cruz Boulevard
Owner DitZ Crane Co. AdVss
1234 Sunnyvale—Sara toga Rd,
By Palla Plumbing Co. Address
Contractor,Agent
0 245-2323
Phone
WILLIPS,'. D.
186579 Approved -------
State License
'4_ Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater r Size
Water Closet —2, Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
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
1-1
Main
Area Drain t Drain Fee i
3Valer Leale, Stom Drain Fee
Sp, " Y, W t"S�
i,kl tem Water Sys. Fee /<T7)
Relief Valve j Gas Fee
Vac Breaker
Skimmer
Filter
Pemit Fee
4Z ,&JV Total Fee