Plumbing Application 11
No. Street Lot No.
a APPLICATION'tFOR.>'rIWUMBI 6. RMIT
CITK/ R'I:IN�
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OCT 3Z �Ss nitaMlti�lermit
E Date October 28, 196 8 8 No.
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3 '' ' y U c ('I IDM- ,.. Fee S �i. 5
Application is hereby made to the City o Cupertino Lo.9a permit to install plumbing pipes
` and/or fixtures listed on the reverse side hereof,and agrees to inst%fl said prices and/or fixtures
o ; in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
C'T laws applicable thereto.
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-c; Useof Premises
Ditz Cram Company229De La Cruz Boulevard
° OwneraAd rerss
Palm Plumbing Co. 1234 ale-Saratoga Rd.
y By Address
3 Contractor,Agent
° Phone 245-2323
m 3 ...
—t State License 186579 Approvedt
/ Plumbing Inspector L/
FIXTURES INUMBER I MAIN DRAIN
Units Fees I Units Fees
Water Heater Size
Water Closet 1 Material
Bath Tub / To Curb
Shower To Prop. Line ✓
Lavatories To Existing
Kitchen ink Not Conn.
Dish Washer
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 `S
Water Leader Storm Drain Fee
Sprinkler System Water Sys. Fce
11 Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total / ,Af7J Total Fee a/