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APPLICAT� F MPERMIT
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Date October 29, 1968 C 1968 Permit No.S// 17-3
Application is hereby made to,the Cityro Cupeatrl'¢�05 4 Aermnit to install plumbing S';ZZ ng 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
laws applicable thereto.
Use of Premises
Owner Ditz Crane
By Palm Plumbing Company
Contractor, Agent
245-2323
State License 186579
De La Cruz Boulevard
3A,-4S,Sunnyvale-Saratoga Rd.
Approved
Plumbing Inspector
Size
Water
Dish Washer
Wash Trav I 1 II STORM DRAINAGE
To Curb