51167.2 (2)I rti / / LOT NO.
NO.�'�`` q.,
�f _QT 6N FOR PLUMBING PERMIT
Ch y OF CUPERTINO
W2 o MAY 6 1968 Sanitary NO. _
o a Date May 2, 196 $ Pcnnit No ��� 7
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o 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 w Cupertino, and all other laws applicable thereto.
w x
� r
J
Use of Premises Dwelling
00
3 OwneDitz Crane Company ?MA,De La Cruz B oulevard
o<
B, Palm Plumbing Co. Add SN. Hwy 9
O y CONTRACTOR, AGENT
— < Phone 2115-2323
.z
0 s State License 186,579 Approved /
a o l�
— U �/ PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material /
Bath Tub / To Curb
Shower / To ProD. Line
Kitchen $ink / Not Conn.
Dish Washer Sewer Dox
Wash TraySTORM
DRAINAGE
WashingMachine
Size
Water Softener
Material
Bar Sink
LTo 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 'f
Area Drain
Main Drain Fee Ir -S
Water
Vac
Permit Fee
Total Total Fee , f —0 t