NO PERMIT NUMBER ;Aq ��,.61LOT NO. aY
NO.
_i
�AP,P.LICA-T.IOWFOR PLUMBING PERMIT
z d QTY!OP CUPERTINO
x o /AUG 12 1968 y
r � Sanitar No.
� 4
o < Date Judy 196 8 Permit No
= LLt i " rt 1 Pees
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a 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
U)
Cupertino, and all other laws applicable thereto.
Ung
a ~ Use of Premises
J
O0 O
a Owner Ditz Crane Company �2A22A� espe La Cruz Boulevard
Z J Palm Plumbing Company Td3'ress vale-Saratoga Rd.
o IIy COtJ
�
3 < 245-223 R, AGENT
— m Phone �JJ
p a 186579 WILLIAM D. SENEVICH
a o State License Approved
`�. -U -41- PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS FEES UNITS FEES
Water Fleater Size
Water Closet Material
Bath Tub To Curh
Shower To Prop. Line v
Lavatories y To Existing
Kitchen Sink i 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
Total } 'Total Fee