51187N Q
Z
Z
4
Iu' U
c
LOT NO.�
ml
I*I"TION FOR PLUMBING PERMIT
I
OF CUPERTMO
Sanitary No.
nate �MAYN�1�68 68 Permit No
Pee S 0210. SZ�
Af�1 F�iogihey� fc�hCity of Cupertino for a permit to install plumbing
pipes and%or xtures� is ed on t e everse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner Ditz Crane Company
Palty Plumbing Company
By CONTRACTOR,AGENT
245-2323
State License 186579
ARRr De La Cruz Boulevard
AReN. Hwy 9
ApprovedVILL1APA D. OCNEVICH
x PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FETES
Water Heater
/
Size
Water Closet
Material
Bath Tub
To Curb
Shower
To Prop. Line ✓
Lavatories
`�
To Existin
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
Hain Drain Fee
Water Leader
11 Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac. Breaker
Skimmer
Filter
Permit Fee 1
Total
11 Total Fee '�