NO PERMIT NUMBER a=444V — 14VJ ' if — i
No Street Lot No. ( /
�NOV 19 1968 tr
d APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
C!TY OF CUPERTINO Sanitary No.
° November 8
E Date , 196_ Permit No.
Y
° Fee
3
s 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
0 ,; in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
"P laws applicable thereto.
v
0
� ;, Use of Premises Dwelldne
Ditz rens ompany 2295 De La Cruz Boulevard
° Owner Address
o .
° N By Palm Plumbing Company RA;,SSunnyvale-Saratoga Rd,
3 z Contractor,Agent
0 245-2323
g� 3 Phone
State License ���i'-r7 /Approved WILLIAM D. BENE!!
�/ Plumbing Inspector
FIXTURES NUMBER MAIN DRAIN
Units Fees Units JFecs
Water Heater Size
Water Closet „Z Material
Bath Tub To Curb
Shower / To Prop. Line JJ
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer
Waste Disposal
Wash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink To Main Drain
Comb.Sink&Tray To Curb
Dental Unit
Drinking Fountain
Floor Drain WATER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee 33�
Area Drain Main D ' Fee
Water Drain Fe
Sprinkler System 4Water Sys. Fee �$
Relief Valve, 11 Gm Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee ' �Q,