NO PERMIT NUMBER (3) LOT NO.
APPL ATION 'FOR PLUMBING PERMIT
'z AUG ti,. 1:,6H CITY OF CUPF.RTINO
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x o Sanitary No.
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3 a Dare—r "t_ aU3.-Yr7"' ;"7968 Permit No
w LL Fee $ a 3. J--6
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� 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
a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
w Dwelling
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Use of Premises
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0 Ditz Crane Co 2pqK
3 Owner "�� 2A8 rens La Cru? Boulevard
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z z B Palm Plumbing Compaby ]?��feSunrWvale-Saratoga Rd.
J O y CONTRACTOR, AGENT
3Phone 245-2323
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a 186579 WILLIP.Mfi D. L_:' :'!:Ca
n f State License Approved
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U ?",PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater / Size
Water Closet oL Material
Bath Tub To Curb
Shower To Prop. Line
Lavatories 2. 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 MainDrain Fee
Water Leader Stomp Drain Fee
Sprinkler Valve I Water Sys.Fee
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee rp
Total Total Fee o�