NO PERMIT NUMBER LOT NO.
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')AP,PLI6AT
z Z12 ION ORI PLUMBING PERMIT
1 CITY OF. CUPERTINO
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X ' . (AUG( 1968 sanitary No
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0 Date 'r 196 8 Permit No
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LL . �± I -PIT! Pee $ G'Sy
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� Application is hereby, made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Q w Cupertino, and all other laws applicable thereto.
wx
Dwelling
LL Use of Premises
00
' 02295 De La Gras Boulevard
i- 3 Owner DitS Crane Company Address
j Palm Plumbing C 33,2111z B omPaT�Y l 2d2ress�y�e�aratoga Road
O y CONTRACTOR, AGENT
Phone 2115
323
w z WILLIAM D. BENEVICH
State License 186579 Approved
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PLUMBING INSPECTOR
FIXTURES I NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water I{eater11 Size
Water Closet Materinl
Bath Tub To Curb
Shower / To Prop. Line
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 8 Tray To Curb
Dental Unit
Drinking 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
Skimmer
Filter
Permit
Total Ljotal Fee a J�