NO PERMIT NUMBER LOT NO.
NO. S l'
APPLICAU N�Si IG PERMIT
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i O OCT
U 1968; Y�I�'o.
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o a Date S9ptmRber 196_ Permit No
3 7 /
? LL ITV nn� �•�°ERTII�;O Pee $ oC b• `S
O Application is hereby ma
'V Fee
of upertmo for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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.
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a Use of Premises Dwelling
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00 De La Cruz Boulevard
r 3
Owner Ditz Crane Co/ Address
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B Palm Plumbing Company 12ALLSunnyvale-Saratoga Road
J O y CONTRACTOR, AGENT
- < Phone 215-2323
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u Y State License 186579 Approved -
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(r
0 � PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNI'f5 FEES UNITS FEES
Waterlieater / 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 Troy STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap 'TOTAL FEES
Urinal Fixture Fee //-
Area Drain Main Drain Fee
Water Leader Stom Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee