51177.1KI
LOT NO.
NO. STREET
P TW! PLUMBING PERMIT
Q7bY UPERTINO
1✓ 0 � Sanitary iNo.
Date { //���� ��9❑❑7[[UDD119T96— Permit No-
Fee
o '���/ % %• i
nnCC n�lrlfoL RTI1 o Pee $ �Cns
Applicat�'g�Ti�hc�� I f Cupertino for 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 Si g1e Dwelling
Owner Ditz Crane Co. 229A5dreFssLa Cruz Blvd„ S. C.
By Bohart Plumbing Co. 167 X& Jremont Ave., BI vale
CONTRACTOR,AGENT
Phone 245-2323
State License 186579
7.10-70 Oaf
Approved
PLUMBING INSPECTOR v
FIXTURES
INUMBER
11 MAIN DRAIN
Units Fees
Units Fees
Water Heater
/
Size40(
Water Closet
Material
Bath Tub
ToCurb
Shower
/
To Pro,
ro . Line v
Lavatories
Existing
Kitchen Sink
Not Conn
Dish Washer
Waste Disposal
Wash Tray
STORM DRAINAGE
Washiny, Machine
/
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinking Fountain
Floor Drain
WATER SYSTEM
Ho r
Size
Restaurant Sink
Material
Sand Tra
TOTAL FEES
Urinal
Fixture Fee (i
Drain
Main Drain Fee
Water
Fe
S rinkler S stem
11
Water S vs. Fee
Vac Breaker
Skimmer
Filter
Pool Sweeper
'
Permit Fee
Total
,$
Total Fee