Pluming Application d I JLOT ,
NO. ��, ST0.ER.y
e`—Lp#LI ATION. FOR PLUMBING PERMIT
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CITY OF CUPERTINO
r o AUG 12 1968 l Sanitary 1o.
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o a Date July 196 8 Permit No
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o Application is hereby made to the City of Cupertino for a permit to install plumbing
'o 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
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Cupertino, and all other laws applicable thereto.
~ r Use of Premises DwelLing
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31 3 Owner Ditz Crane Company 2 ,,Pe ria Cruz Boulevard
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By Palm Plumbing Company Actress Sunnyvale-Saratoga Road
CONTRACTOR, AGENT
3 245-2323
Phone
w zBENEVIGH
186579 WILLIAM D.
I' o o State License Approved /
1 -U PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNI 'S FEES
Water Heater Size _
Water Closet Material _
Bath Tub To Curb
Shower To Prop. Line ✓
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
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 Valve Water Sys.Fee
Relief Valve Gas Fee /
Vac Breaker
Skimmer
Filter
Permit Fee
Total 'rota)