51167.2STREET
LOT NO. .7-9
'M sAPPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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Sanitary No. t�r�FZ/%
�JUL 31 Jam, a / /
° J Date- 196— Permit No
5-0
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� ° � Application i's:hereb}' made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed bn 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
wCupertino, and all other laws applicable thereto.
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Use of Premises Dvel3J=
22d5 De La Cray Boulevard
Owner Ditz CFane Comnaxty A ress
By Palm PlIzabing Company
CONTRACTOR, AGENT
245-2323
State License 186579
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d�es3 male -Saratoga Road
Approved
PLUMBING INSPECTOR
X
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Wafer Heater
Size
Water Closet
Material /
Bath Tub
/
To Curb
Shower
/
To Prop. Line
Lavatories
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 R Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
I
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total
t7 /$1C-0
Total Fee do g(f7/