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tFOR PLUMBING PERMIT®JUL
1319V" ,.OF CUPERTINO
Sanitary No.
DateIVO Permit No
IV Fee $ off- �' 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 laws applicable thereto.
Use of Premises Single Dwelling
Owner Ditz Crane Co. 229Ay g La Cruz Blvd, S. C
B Bohart Plumbing Co. 161Ah� Fremont Ave., SIvale
Y
CONTRACTOR, AGENT
Phone 245-2323 n n
-7 0 O'�1/W .WtCi'/�
State License 186579 Approved
PLUMBING INSPECTOR C/
FIXTURES NUMBER MAIN DRAIN
Units FeesUni Fees
Water Heater Size
Water Closet Material
Bath Tub To Curb
Shower To Pro .Line
Layatories _ •. -� To Existine
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
Ho er
Size
Restaurant Sink
Material
Sand Tra
TOTAL FEES
Urinal
Fixture Fee (/
Are ain
Main Drain Fee -
W e
F
Sprinkler System
Water Sys. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
Permit Fee
Total
Total Fee