NO PERMIT NUMBER (3) Q' I LOT NO. V /
NO. S'rk EE.
w < APPLI/ATII PERMIT
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4 bZ3
�J(Nnitti 'o.
° a Date Septembe I 19I Permit No
3 3, sa
° Application is hereby ma IT' City ohC1p�tRT�S'�'a'permit to install plumbing
o � pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w i '
~ Dwellj.Ag .
J 4
Use of Premises
00
3 OwnerDitz-Crane Compaay AdHrssBe La Cruz-Boulevard
B Palm Plumbing Company SSum*,vale-Saratoga Road
° y CONTRACTOR. AGENT
3 <
` 245-23233
— m Phone
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u s 186579 Approved WILLIAM D. =NEVICH
Q ° State License
—U PLUMBING INSPECTOR A/
II � I
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNCrS FEES
Water Heater Size
Water Closet 'Z. Material
Bath Tub / To Curb
Shower / To Pro . Line
Lavatories To Existing
Kitchen §ink Not Conn.
Dish Washer Sewer Box
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 FFsES
Urinal Fixture Fee V
Area Drain ._ Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee /
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee ���'