51167.2 (2)LOT NO.
o. s
'r T N FORCPLUMBING PERMIT
< C.JtrY OF UPERTINO
f MAY 6 1968 sanitary No.
0
0 < DSS 2, 196 8 Permit No 7. L
wU f(r y �r "PEPM-19 �3 s�
LL C. T„.�i Fee
O Application is hereby made to the City of Cupertino for a permit to install plumbing
oa pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i- 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.
w x
r r
Use of Premises Dwelling
00
i- 3 Owner Ditz Crane Company A2�g 5 De La Cruz Boulevard
Oa
Palm Plumbing Company AJAAN. Hwy 9
J O By CONTRACTOR, AGENT
3
0 Phone
245-2323
—
.Z {
ww
u f State License11 A��o Approved
a o
—,V PLUMBING INSPECTOR
a- Y
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
I UNITS FEES
Wate,W{ ater
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 DRAINAGE
Washing Machine
/
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Trn -
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TO'T'AL FEES
Urinal
Fixture Fee S
Area Drain
Main Train Fee
Water Leader
Storm Drain Fee
S rinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee /16' v
Vac Breaker
Skimmer
Filter
Permit Fee
Total
Total Fee -OJ.