NO PERMIT NUMBER (3) ee'h Lot No.,��
51
E � �,NQV 19 19WPLIICACION FOROF PLUMBIING NG PERMIT
UPER°
U Sanitary No.
OP OF ����TIP.'(�
E Date NOV r 1 6 8 Permit No.
x
i3: Fee S-23, '5--0
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
° in accordance with the provisions of the Plumbing Code of the City of Cupertino,and all other
'c laws applicable thereto.
° Dwelling
A Use of Premises
w Ditz Crane ompany 2295 De La Cruz Boulevard
° Owner Address
By Palm Plumbing Comp=W 1 ,�unnyvale-Saratoga Rd.
Contractor,Agent
$ 245-2323
Phone
3
-u State License 186579 Approved Plumbing
Plumbing Innsspecctortor 0. GH
�
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater / Size
Water Closet Material (i
Bath Tub To Curb
Shower To Prop. Line
vat 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
Area Drain Main Drain Fee
W aStom Dr, in Fee
S rinkler System Water Sys. Fee
Relief Val�,, Gaq Fee
Vac Breaker
Skimmer
Filter
Permit Fee
Total Total Fee i