51167.2LOT NO. JG
P_LiC2ATION, FAQQQI1PLUMBING
CITY QL-;CUPERTINO
���jf
PERMIT
JUL 19 1968 Sanitary No.
Date dune , 196- Permit No 's��67• ^2
CITY 0I til; RTI�!0 Fee S a `.
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes 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
Cupertino, and all other laws applicable thereto.
s 7 9Y
Use of Premises LfwelliTrg
Ditz Crane Company 2 295 De La Cruz Boulevard
Owner A ress
Palm Plumbing Company
CONTRACTOR, AGENT
__ 245-2323
State License 186579
AsSunnyvale-Saratoga Rd.
Approved
\ PLUMBING INSPECTOR . /
FIXTURES
NUMBER MAIN DRAIN
UNITS FEES UN
Water Heater
/ I Size
Water Closet
Material /
Bath Tub
/ To Curb
Shower
/ To Prop. Line
Lavatories
To Existing
Kitchen Sink
/ Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash Tray
STORM DRAINA
Washin Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixtarc Fee
Area Drain
Main Drain Fee L
Water Leader
Storm Drain Fee
S rinkler Valve
Water Sys. Fee
Relief Valve
Cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee ci
Total
Total Fee