51167.2 PLUMBING /OO/NO NO. s'r�nj(g�+[/� LOT NO.
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`APPL`ICATION`? FOR PLUMBING PERMIT
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a �!j CITY OF CUPERTINO
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0M AUG 12 1968 sanitary nen.
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o Date 'TU1Y 196-8 Permit No
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r-,,;—\f nr Ci 1prC;T10 Fee $ `;2 `S�
O Application'is hereby made to the City of Cupertino for a permit to install plumbing
o 1- pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 1- 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.
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Dwelling
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.. Use of Premises
002295 De La Cruz Boulevard
3 Owner Ditz Crane Company Address
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By, Palm Plumbing Company S?=q%raleSaratoga Rd,
O CONTRACTOR, AGENT
3 < 245-2323
— w Phone
w z WILLIpNi l2. BENMCH
0 186579 a
u s State License Approved
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PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size 14
'Water Closet Material
Bath Tub To Curb
Shower / To Prep. Line
Lavatories l2 To Existing
Kitchen ink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Wash Tray STORM DRAINAGE
Washin Macbine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&'Fray 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 i
Water Leader Storm Drain Fee
S rinkler Valve Water Sys.Fee 114-21)
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total / Total Fee .3 /