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NO. SIRjF.7" -
r PkidATION, FOR, PLUMBING PERMIT
CITY WCUPERTINO
S,�APR n 1968 �, Sanitary No.
Dat, March 29 1968 196— Permit No
t Fee Sy2 (o. Sy
Application is hereby made to the City of Cupertino for a permit to install plumbing
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 Co
By Palm Plumbing Co.
CONTRACTOR,AGENT
Phone2)15-2323
State License 18A579
Address 2295 De La Cruz Blvd,
Address 7.2311 N. Hsey 9
If
PLUMBING INSPECTOR ✓
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
/
Size
Water Closet
Material
Bath Tub
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen Sink
/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash 'Fray
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
TO'T'AL FEES
Urinal
Fixture Fee 1
Area Drain
Main Drain Fee IS f�
Water Leader
I Stom Drain Fee
Relief Valve
Vac Breaker
Total
Total Fee