51167.33 �
No.
Lot No.
APPLICATI j
'FQR P N
CIT61NOVF t'tJP. TI
dui ry �
27 ��t
Date October 29, 11966 error No7,3
UTY OF C�I�r�� 'fib Fee 5 , sa
Application is hereby made to the City of upertm NI install plumbing 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 Cupertino, and all other
laws applicable thereto.
Use of Premises
Owner Ditz Crane Co.
By Palm Plumbing Co.
Contractor, Agent
Phone 245-2323
186579
State License
Dwelling
�?l$�SDe La Cruz Boulevard
W&r ss Sunnyvale -Saratoga Rd.
\' APpro WILLIFuM J. ::.":VEVICH
J� Plumbing Inspector
Heater
Material
v
Comb.Sink & Trav I 1 II To Curb I I
Floor Drain I 1 II WATER SYSTEM
Sink
Water
Permit Fee
Total Fee