NO PERMIT NUMBER I G:2224�'/."Z'-Z/ LOT NO.
NO. STREFrI/
APPLICATION FOR pEppL�! UU,,MBING PERMIT
" < IT s0 Ct3.PHRI
z z 4m
f"o m IN No.
No.
Y
Q LL
O < October �4 1968
o < Date 96 emit No
w LL Pee $ 3. J
o
4 w Application is hereby made to tFF;e� ity '� �f((SS�� a permit to install plumbing
O pipes and/or fixtures listed�n �hclrG ers�i5inethe�rbC!�-a agrees to install said prices
> < and/or fixtures in accordz cc'with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
w x
LL Use of Premises DWell�
00
> W Ditz Crane Company 2AV De La Cruz Boulevard
3 Owner ,ss
oa
B Palm Plumbing Company ]� e5$unrryvale-Saratoga Rd.
J O y CONTRACTOR, AGENT
3i= 245-2323
— m Phone
w w WILLL"SA D. B=NGVICH
0 State License. 186579 Approved
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNH'S FEES
Nater heater Size
Water Closet 2- Material
Bath 'Pub To Curb
Shower To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee �26fT
Total j$a Total Fee �`S�