NO PERMIT NUMBER (3) LOT NO. /
NO. /_ TREB
APPLICATION FOR PLUMBING PERMIT
W 'AUG 12 1560UYTY'1OF CUPERTINO
r a Sanitary No.
o a Date `v "�/ 1— J am.-�v196 8 Permit No
w U Fee $
2 LL
O Application is hereby made to the City of Cupertino for a permit to install plumbing
a a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r . 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.
r
Dwelling
j LL Use of Premises
00 �qk
3 Owner Ditz Crane Company �33kesDo La Cruz Boulevard
0 <
B Palm Plumbing Company )Nkspuunr�pvale-Saratoga Rd.
J O y CONTRACTOR, AGENT
0 Phone—one 2115-2323
w i WILLIAM D. BENEVI—,
ww
a o State License 18579— Approved
—U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet t, Material f�
Bath Tub To Curb
Shower To Prop. Line t/
Lavatories 'T'a 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 B 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 All S-11�1
Area Drain Main Drain Fee
Water Leader Storm Drain Fee
Sprinkler Valve Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
P,;;;it Fee .
Total / /V/SopTotal Fee