NO PERMIT NUMBER (3) LOT NO.
NO. S EF.T
APPLICATIO=N WING PERMIT
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, 0 u t1. yl N u.
LL October f 0cT 8 �s6$ ci'mit No
o Date
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w LL Pee $ ��_SZl
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Application is hereby r aJ�ello it�b� py,Pro qr a permit to install plumbing
`o pipes and/or fixtures listed ori the reveise�std -Nerco , and agrees to install said prices
> 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 2
.. Use of Premises Dwelling
00
3 Owner Ditz Crane Coim Addy De La, Cruz Boulevard
Address
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J jB Palm Plumbing Company ]A2eSSunnyvale—Saratoga Rd.
O y CONTRACTOR, AGENT
3 < Phone 21r5-2323
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"a 186579WILLI M D. L--NZVlCH
o State License Approved
p— U PLUMBING INSPECTOR //
FIXTURES I NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closet �-g i1%aterial 6i
Bath Tub To Curb
Shower To Prop. Line
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 B Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink 61ate6al
Sand Trap 'TOTAL FEES
Urinal Fixture Fee
Area Drain I Main Drain Fee
Water Leader. Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total // e s� I Total Fee a//�