51167.2 (2)N Q
W Z
LOT
NO.
P�BT�A71 FOR PLUMBING
�SY�ice,T1 CUPERTINO
M
Sanitary Nr
Date Y'�Y 13 f968 g8 Permit ^
PERMIT
(� 7
lstT,/ r, ^� Fee $ c"- - 1�
Applicatioh �s�lie`reby��1?c��-,�pq7��•,��; ��y of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on here. Ise side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
OwnerDitz Cr n�P Cn
Palm Plumbing Co.
CONTRACTOR, AGENT
2452323
State License 186579
2335 De La Cruz Boulevard
ress
)i &' s�l. Hwy 9
. PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
"
UNITS FEES
UNITS FEES
Water Heater
/
Size
Water Closet
�—R
Material
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 & 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 e+?Gt7i
1 Total