51167.2ZJ lit I � LOT NO. T7
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CIIPFRTINO
Sanitary No.
5-936.
Dnt'F� i 1968 Permit No S7/67 2
Fee bac
Applwation pis -here:, mad P the City of Cupertino for a permit to install plumbing
pipes and cir fizzy «Is rkiFted n t lie 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
Cupertdno and 11 her laws applicable thereto.
U, I 1 0r OPERTIAel 0 _
Use of Premises
Owner Ditz-Craae Company
By Palm Pl�bing Compares
O CONTRACTOR,AGENT
3 245-2323
— m Phone
W w 'tate License 186579
U
23?�rDe La Cruz -Boulevard
ess
134A!1�Saratoga Road
Approved
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
11 UNUS FEES
Water Heater
I
ISize
Water Closet
Material (%�•
Bath Tub
To Curb
Shower
To Prop. Line 411
Lavatories
To Existing
Kitchen ink
/
Not Conn.
Dish Washer
Sewer Box
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
Rapper
Size
Restaurant Sink
Material
Sand Trap
TOTAL FEES
Urinal
Fixture Fee IL515SO
Area Drain
Main Drain Fee S-11FO
Water Leader
Storm Drain Fee
Sprinkler Valve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skinner
Filter
Permit Fee
Total
1,36 D
Total Fee �2