NO PERMIT NUMBER No. Street Lot No.,.?
y
a APPLICA�QW- P.L-Ul.,.IN PPVRMIT
E f qI�Y OF CUP?
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l CT 31
1968sanitary/No.
E Date October 28,017 9618,-. Permit No.
o C"P r Fee s.2-4, J?J
3
z Application is hereby made to the City of Cupertino or a permit to install plumbing pipes
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
laws applicable thereto. _
o Dire
lling
m Use of Premises
° Ditz Crane Co. 22$5 De La Cruz Boulevard
' E Owner Address
o ..
ti By Palm Plumbing Company n34sSunnyvale-Sarat0ga Rd.
3 Contractor,Agent
Phone 2452323
A
State License 186579 Approved
1— Plumbing Inspector
FIXTURES NUMBER I MAIN DRAIN
Units Fees I Units Fees
Water Heater / I Size
Water Closet 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
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
I Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total / Total Fee