NO PERMIT NUMBER (2) iLOT Z'e
N�, l:J S� F�, 1� 1`�
1/ �APPL-ICATION FOR PLUMBING PERMIT
z d CITY OF CUPERTINO
!AUG 12 i968
x o Sanitary No.
� LL
o a Date J111.y 1968 Permit No
Fee $ .3.S�
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 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.
Dwelling
LL Use of Premises
0 o
> � Ditz Crane Company 219 De La Cruz Boulevard
0 3 Owner cess
o-B Palm Plumbing Company 12 V, Sunnyvale-Saratoga Road
J 0 y CONTRACTOR, AGENT
3 <
Phone 245-2323
—
w z WILLIAM D. BENEVIGH
u Y State License 186579 Approved
a o
PLUMBING INSPECTOR , /
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater Size
Water Closet y Material ev
Bath-Tub To Curb
Shower / To Prop. Line ✓
Lavatories To Existing
Kitchen Sink Not Conn.
Dish Washer I 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
Filter
Permit Fee
Total 1 Total Fee �',�