51167.2.AE, I /�I � ��n ✓11 � t.->� LOT NO. �
NO. STREET
APPLICATION FOR PLUMBING PERMIT
w d CITY OF CUPERTINOzi
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�m Sanitary No. �a 33
0a DateJ11�196 8 Permit No S/( 6%- ""Z'
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/ljpp�ication is hcreb}de the City of Cupertino for n permit to install plumbing
o 1 pipes aKcl of (xtures listed o e'ieverse side hereof, and agrees to install said prices
i a and/or fiuresrrrt dance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all✓ofejh�p�Va_pplicable thereto.
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Melling
Use of Premises
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3 Owner Ditz Crane CompBgy 2 ale La Cruz Boulevard
z 12Vt Suzmyvale-Saratoga Road
J By Palm PlwaUng Company Adddress
O 2, 5_�(gTSACLOR, AGENT
3 a jl7 j[3
— Phone
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F State License 186579 Approved /
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water heater Size
Water Closet Slaterial
Beth Tub To Curb
Shower / To Proo. Line v
Kitchen Sink /
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
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
I Storm Drain Fee
SprinklerValve
Water Sys. Fee
Relief Valve
Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee o70yll
Total //
/�C-;f I Total Fee .,7 6 cr1