NO PERMIT NUMBER --tt
LOT NO.
ZN� �APPL CATION FOR PLUMBING PERMIT
z i 8 1568 uV-y: of cuPFRTINo
x 0 Sanitary NO.
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0a Date dU�y --•• --�—•, 196— Permit No
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
'opipes 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
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Cupertino, and all other laws applicable thereto.
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LL Use of Premises Dwelling
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> w Ditz Crane Company Wa De La Cruz Boulevard
3 Owner ess
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J , Palm Plumb Co ���qq������ ��+ ale-Saratoga Road
� z By � ��' ifc}dThsY�O
O - CONTRACTOR, AGENT
3 2115-2323
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aLL 186579 Approved WILLIAM D. BENEVI�=:1
a o State License
U � PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater / Size el
Water Closet Material
Bath 'rub / To Curb
Shower / To Prop. Line 1/
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
Drin king Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap 'TOTAL FETES
Urinal Fixture Fee Ile,
Area ]rain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total // /G Total Fee "9