51187 Plumbing ApplicationI
NO.
AL�EF
I@N� FOR PLUMBING PERMIT
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UPk:RTINO
xa / t N Sanitary ii'so s- 7a
3 a Uate 7 / , 12 1968 19 Permit No 16— L
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4 QTY G�jR ps Pee $ >�
° Apphca n i h y Ilily f Cupertino for a permit to install plumbing
`o w pipes and/or fixtures listed on the revcr side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a in
Cupertino, and all other laws applicable thereto.
Dwelling
Use of Premises
00
> W Ditz Crane Co. 22?5 De La Cruz Blvd.
r 3 Owner A dress
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Zj Z a Palm Plumbing Co. IA2 C,sunnyvale—saratoga Rd.
J ° y CONTRACTOR, AGENT
3 m Phone 245-2323
wZ
a WILLIAr.9 D. per. mrl! • I
o o State License 186579 Approved
_ U PLUMBING INSPECTOR
_FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
v7
Material (-
Bath Tub
To Curb
Shower
/
To Prop. Line
Lavatories
To Existing
Kitchen §ink
/
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
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
11 Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
/
Total Fee ..5�: