NO PERMIT NUMBER (3) iLGy(/ Lor NO./
NO. STREE
, ;APPLICAT.ION FOR PLUMBING PERMIT
z � CITY OP CUPERTINO
Y o -� I AUG 12 IS68 F Sanitary No.
a _
o a Date July 196_ Permit No
Pee $ 02,
LL
O Application is hereby made to the CityofCupertino 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
a w Cupertino, and all other laws applicable thereto.
wx
< ,. Use of Premises Dwelling
00
> 0 Ditz Crane Company 29 5 De La Cruz Boulevard
0 3 Owner Address
oa
zz a Palm Plumbing Company sSunnyvale-Saratoga Road
J O y CONTRACTOR, AGENT
— m Phone
2115_2323
w z WILLIAM D. BENEVICH
WW
a o State License 186579 Approved
—U _ J PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNrrS FEES
Water heater Size
Water Closet Material
Bath Tub To Curb
Shower 'I'o Prop. Line ✓
Lavatories s 3 11 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 SYS'T'EM
Hopper Size
Restaurant Sink Material
Sand Trap 'TOTAL FEES
Urinal Fixture Fee /
Area Drain Main Thain Fee
Water Leader Storm Thain Fee
Sprinkler Valve Water Sys.Fee /0-01
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ��—
Total (p Total Fee ��/