NO PERMIT NUMBER (3) LOT NO.
NO.
�APPLI_IAT ON,FOR PLUMBING PERMIT
p < V CITY OF CUPERTINO
xo AUG 12 1968 Sanitary No.
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o < Date JU1Y 196-8 Permit No
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w (`'-�r ',- 17�n•: ;� Fee S
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and all other laws applicable thereto,
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DwellingUse of Premises
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C) 0 9'O[
i- 3 Owner Ditz Crane Comoantp A3�fesDe La Craz Boulevard
oa
ZjPalm Plum
0 By Company_ Ss uu',yvale-Saratoga Road
� O CONTRACTOR,
AGENT
3
W Phone 245-2323
–
. Z WILLIAM D. Sr--'NEVI"
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State License 186579 Approved /
\Z' -U r PLUMBING INSPECCOR V
FIXTURES NUMBER MAIN DRAIN
IINIT5 FEES UNITS FEES
Water Ileater / Size
Wator Closet .Y Material
Bath Tub To Curb
Shower To Pro Line 61�
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash 'Fray STORM DRAINAGE
Washin 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
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 a`