NO PERMIT NUMBER LOT NO.-,2!�No �
i 'j APPLICATION .FOR PLUMBING PERMIT
z < + r I 1 p 196CgITY�OF CUPERTINO
x p - Alli 12 Sanitary No.
O a' Date dLL� 196 8 Permit No
3 '—\ fit
Fee $ OZ6—ST)
2 0
Application is hereby made to the City of Cupertino for a permit to install plumbing
`o 1- pipes and/or fixtures listed on 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
a w Cupertino, and all other laws applicable thereto.
wx
a Use of Premises Dwel ling
00 g��C7�I�
3 Owner Ditz Crane Cotl�agy a2a5 a La Cruz Boulevard
O <
Jz By Palm Plmnbing Co
npa� } ,Sve� Rd
O
CONTRACTOR, AGENT
3a
— Phone 245-2323
w z
w w WILLIAM D. BENEVICH
rI a o State License 186579 Approved /
j�
—U 'JY\ PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water floater Size
'Ta-t;; Closet Material
Bath Tub To Curb
Shower / To Pro . Line
Lavatories To Exi stin
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
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
Fi Iter
Permit Fee e2�
Total Total Fee o2�j�0