NO PERMIT NUMBER LOT NO.
No. STREET7'-'
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APPLICATION FOR PLUMBING PERMIT
N (AUG 12 19bf3TY ON CUPF.RTINO
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x 0 Sanitary \0.
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0 Date July �.1 6� Permit No
uFee $ �9- 6. eSy
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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
> : 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.
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LL Use of Premises M11{ng
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30 Ditz Crane Company Vppqd5 De La Cruz Boulevard
3 Owner A3"dress
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J B Palm Plumbing Company 12.1Sunnyvale-Soratoga Road
J o y CONTRACTOR, AGENT
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< 245-2323
— m Phone
w z WILLIAM D. BENEVICH
u f State License 186579 Approved
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0 PLUMBING INSPECTOR V
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Mate,Ileater Size
Water Closet Material C/
Bath Tub / To Curb
Shower / To Prop. Line
Lavatories To Existing
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&Troy To Curb
Dental Unit
Drinkin Fountain
Floor Drain WATER SYSTEM
Hopper Si ze
Restaurant Sink Material
Sand Trap TOTAL FEES
Urinal Fixture Fee
Area Drain I Main Drain Fee
Water Leader Stoma Drain Fee
Sprinkler Valve Water Sys. Fee /Iro
Relief Valve Gas Fee
Vac Breaker
Skimmer
Filter
Permit Fee d�
Total Total Fee Q