NO PERMIT NUMBER J �
ro I J - ,I i LOT NO.
NOt J• S E
'0:'
tAPPLIC TION \FOR PLUMBING PERMIT
z a It I AUG 1 2 1 J68 CITY OF CUPERTINO
z
x o Sanitary No.
� LL
0 a Date •- -- -- J11 — 196_8 Permit No
3 u Pee $
W LL
Application is hereby, made to the Cit}' of Cupertino for a permit to install plumbing
`opiPC'
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.
ing
,. Use of Premises Dwell
00
0Owner Ditz Crane Company 392 eSDe La Cruz Boulevard
oz By Palm Plumbing CompanySj 1234 S 'ale-Saratoga Rd.
o ACTOR, AGENT Addres
3 245-TO
— 0 Phone
w z WILLIAM D. BENEVIC}i
0 LL 186579
a o State License Approved
-U PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Prop. Line L/
Lavatories j 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
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 1,10SV Total Fee a