NO PERMIT NUMBER LOT NO.
NO. 5' F.F.I'
APPLI A, P lIB PERMIT
a T 'R P CUP�;�T�N
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so fOCT 8 1968mit r� ,
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3�0 a Date October , 196-P Permit No
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o Application is hereby ma to the C ty 0P�It'
rfmo for a permit to installplumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 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.
w x Dwelling
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Use of Premises
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7 N Ditz Crane Company 2A2�d5 De La Cruz Boulevard
0 3 Owner ress
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z B Palm Plumbing Company 1A2,&, ale.saratoga Rd.
O y CONTRACTOR,AGENT
3 < 215-2323
- W Phone
w WILLIAM
s State License 186579 Approved
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PLUMBING INSPECTOR �/
FIXTURES I NUMBER VAIN DRAIN
UNITS FEES UNITS FEES
Water [eater Size
Water Closet L Material L/
Bath Tub / To Curb
Shower / To Prop. Line
Lavatories l 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.SinkRTray To Curb
Dental Unit
Drinking Fountain
Floor Thain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Thain Main Drain Fee
Water Leader Stom Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee oz��
Total Total Fee e?�3s0