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ANOR PLUMBING PERMIT
MAY 6 1968 CI Y'OF CUPERTINO
Sanitary No.
Date May 21, _19 8 Permit No S // w 7. L
i , i '�L..`f. !..f) FeeS-t
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 Cruz Boulevard
OwnerDltz Crane Co. Address
B Palm Plumbing Co. AlA?e4sN. Iiwy 9
By CONTRACTOR, AGENT
245-2323
186579 Approved WILLIAM p.
State License
l PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
Material
Bath Tub
To Curb
Shower
/
To Prop. Line
Lavatories
�,�
To Existing
Kitchen Sink
/
Not Conn,
Dish Washer
$ewer 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
Alaterial
Sand Trap
TOTAL. FEES
Urinal
Fixtare Fee � r
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
as Fee
Vac Breaker
Skimmer
Filter
Permit Fee(��
Total
Total Fee /