51167.2/OO l�� I,///i/YJ a?�d LOT NO.(✓ D
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO��
Sanitary No.
Date�1 r`J ,l H
1968 Permit No
U Fee $ a6 �—
Apr plicati9n Is hereby. mad toothe City of Cupertino for a permit to install plumbing
pipes'andfbufixtures ISFed c�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
,Mi Yno,, ,' od all other laws applicable thereto.
CUPERTINO
Use of Premises Dwelling
Mt2 Crane Company 2A2d9 eSpe La Cruz Boulevard
By Palm Plumbing CompwW 12 Vi SnT ova] e�aratoga Road
CONTRACTOR,AGENT
215-2323
State License 186579
Approved
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
'
UNrTsj FEES
UNITS FEES
Water Heater
/
Size
Water Closet
Material
Bath Tub
/
To Curb
Shower
/
To Prop. Line i. -
Lavatories
Lavatories
To Existing
Kitchen Sink
I/
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
Wash 1my
STORM DRAINAGE
Washing Machine
Size
Water Softener
Material
Bar Sink
To Main Drain
Comb.Sink & Tray
To Curb
Dental Unit
Drinkin Fountain
Floor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee /
Relief Valve
Gas Fee
Vac Breaker
Skinner
Filter
Permit Fee 2.eO
Total
/457J
Total Fee -2./ffl'7)