NO PERMIT NUMBER LOT NO. �a/o
STREET
No. APPLICATION FOR PLUMBING PERMIT6 /g
a CITY OF CUPERTINO
Y a Sanitary No.
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g ; ® uguec ir, �i7o
3 V e AQG 197Q 196Permit No
—
I a / Fee S.,2 2-�--
° Application is hereb}' made to the City of Cupertino for a permit to install plumbing
n he reverse side hereof, and agrees to install said prices
[ure3utJfCtaftllrldcYWith the provisions of the Plumbing Cale of the City of
a w Cupertino, and all other laws applicable thereto.
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a Use of PremisesSingleSingle Dwelling
00
> 0 Owner Ditz Crane Co. A?d7d95sDe La Cruz Blvd., S. C.
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J , By L. C. Bohart Plumbing + A�§7esp• Fremont Ave. , S/vale
° CONTRACTOR, AGENT
-30
- Phon245-2323 w
8-21 70
W W
¢ a
° f Slate License 7 R�579 Approved
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_V PLUMBING INSPECTOR ✓
FIXTURES NUMBER MAIN DRAIN
Units Fees Units Fees
Water Heater Size
Water Closet Material /
Bath Tub To Curb_
Shower / To Prop.Line L/
Lavatories To Existing
Kitchen SinkrNot Conn.
Dish Washer
Waste Disposal
Wash Tray 'STORM DRAINAGE
Washing Machine i 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 I /
Area Drain Main Drain Fee Cf--V-V
Water LeaderFee
Sprinkler System Water Sys.Fee
Relief Valve G,q Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total Total Fee �P