NO PERMIT NUMBER I 0,/L yy ,/r7✓ ei LOT NO. �D
No. ] A i`r�'jT\�
APPLICATION—FOR,'PLUMBING PERMIT
z IY
OF CUPERTINO
w Z (AUG 12 l 6
' 0 Sanitary No.
1W
o w Date July 196 8 Permit No
w l. ; Lcs( _nT„ ..� Fee c;2 6. SZ)
1 LL
O 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 saidrices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
<w Cupertino, and all other laws applicable thereto.
wx
< rel 1ng
j LL Use of Premises
00
3 Owner Ditz Crane Company 2A55De La Cruz Boulevard
re
oa
zJ Palm Plumbing
Z By Company 12ViNo.Sptuulyvale-Saratoga Road
J O CONTRACTOR, AGENT
3 245-2323
— o Phone
. Z WILLIAM D. BENEVICH
u Y State License 186579 Approved J
a O
�_U 3� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES'
Water Heater Si ze
Water Closet Material
Bath Tub To Curb
Shower / To Prop. Line
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer Sewer Box
Waste Disposal
Rash Tray STORM DRAINAGE
Washing Machine Size
Water Softener Material
Bar Sink I To Main Drain
Comb.Sink&TrayTo Curb
Dental Unit
Drinkin Fountain
Floor Drain WA'T'ER SYSTEM
Hopper Size
Restaurant Sink Material
Sand Trap TO'T'AL FEEsS
Urinal Fixture Fee
Area Drain I Main Drain Fee
Water Leader Storm Thain Fee
Sprinkler Valve Water Sys.Fee /
Relief Valve Gas Fee
Vac Breaker -
Skimmer
Filter
Permit Fee D`9
Total // Total Fee