NO PERMIT NUMBER (3) I I LOT NO.1452
NO. SfR I.El
APPLI TIONR, PG PERMIT
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x o Sari try No.
Date September �0 A68 1966 .,a No
W Pee $� ��1
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Application is hereby m:{de�d�th rity a��. RTJPf�a permit to install plumbing
`o pipes and/or fixtures listed`on t11e reverse stde hereof, and agrees to install said prices
r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
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Use of Premises Dwelling
00
7 N
22P.5 De La Cruz Boulevard
0 3 Owner D�t2 Cr_&Fl@ CO»3I13* Address
_ B Palm Plumbing Company 12�te5S�wc�yvale-Saratoga Rd
J y CONTRACTOR, AGENT
a
245.2323
Phone
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a 186579 WILLIAM D. EENEVICH
a o State License. Approved
PLUMBING INSPECTOR ��
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line v
Lavatories To Existing
Kitchen Sink / 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 WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee s
Area Thain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total 3 Total Fee a�j7l