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f IPP GATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
MAY 6 1968 1 Sanitary Nn.
Date May 2, 196 $ Permit No 4
Pee $ �3..5--6
I,
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
tz Crane Co.
Dwelling
2A95 De La Cruz Boulevard
A rens
B Palm Plumbing Co. AlA?e4s N. Hwy 9
By CONTRACTOR, AGI7NT
V -245-2323
State License 186579
n:L!,'_%' D. ---1Nc111:-i
Approved'."!!'—L!,'—%'
N PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FF.F.S
Water fleeter
Size
Water Closet
•3—
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen ink
/
Not Conn.
Dish Washer
I 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 J
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /
Relief Valve
Gas Fee 5-71
Vac Breaker
Skimmer
Filter
Permit Fee , 2 ,
Total
Total Fee a_ p