Plumbing Application d/✓ / I ��(j_,� LOT NO. �t I
/ APPLICATION FOR PLUMBING PERMIT
z < AUG 11-68 CITY OF CUPp:RTINO
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ro Sanitary No.
0 ' Date n'—r J1119 ---- 1968 Permit No
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O Application is hereby made to the City of Cupertino for a permit to install plumbing
`o r pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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Cupertino, and all other laws applicable thereto.
< Use of Premises Dwelling
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> 0 Ditz Crane Company 2���5 De La Cruz Boulevard
3 Owner ess
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J, By Palm Plumbing Company l344e§unnyyvale-Saratoga Rd.
O CONTRACTOR, AGENT
3 < 21a5-2323
— m Phone
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rca a State License 186579 Approved WILL'A'A D. EEN-VIC4
U v PLUMBING INSPECTOR (//
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Heater H Size
Water Closet .3— Material
Bath Tub / To Curb
Shower / To Prop. Line ✓
Lavatories ,.2.. 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&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 r�
Total Total Fee ��