51167.2 (2)LOT
APPLICATION' FOR PLUMBING
VMAY 6 1968 k.ITY OF CUPERTINO
Sanitary No
PERMIT
DafR t'srnTi 196 8 Permit No ��� 5 7, 2_
Pee $ a(,, S -Z
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse 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
Dwelling
2295 De La Curz Boulevard
Owner Ditz Crane Company Address
Palm Plumbing Co. 12 4 N. Hwy 9
By Ad Less
CONTRACTOR, AGENT
Phone 245-2323
State License
186579 Approved WILLIAM D. BENEVICH
h PLUMBING INSPECTOR N
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Beater
Size
Water Closet
Material
Bath Tub
i
To Curb
Shower
%
To Pro..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
6iaterial
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 Z/�n
' Total I// )G -JV ffotal Fee �7 I