51167.2NO.
LOT NO. 27�
APPLICATION FOR PLUMBING PERMIT
�IrFcY OF CUPERTINO
�� I 1 Sanitary No.
Dat dn?y , 196 8 Permit No'S�l�%•-'�
f JUL J 1 19bb Fee "'2'q S
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes a/ d /t -fixtures-list2d�6nit8e reverse side hereof, and agrees to install said prices
add/or; fixtures im'accdrdencd'e•ith the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises Dwelling
Owner Dtiz Crane Company ,pe La Cruz. Boulevard
By Palm Plumbing Compal+
O CONTRACTOR,AGENT
3'245-2323
- m Phone
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u s
' tate License 186579
a p v
12111 Sunnyvale -Saratoga Road
ess
Approved
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
-
ONITS FEES
ONM FEES
Waier Heater
Gas Fee
Size
Water Closet
Skirmner
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line
Lavatories
C9-
To Existin
Kitchen ink
Total
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
Drinkin Fountain
Floor Drain
WATER SYSTEM
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
'nkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skirmner
Filter
Permit Fee
Total
Total Fee aZ t