51167.2i
LOT NO. /'5/
m O. k
t+� A AT ON FOR PLUMBING PERMIT
MAY 6 j96$ 1 CITY OF CUPERTINO
L Sanitary No.
Idatr.a�-2� 1968 Permit No S milli 7- Z
I ,
ERTI_ Fee S
Application is hereby made to the City of Cupertino for a permit to 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
1 = ra
OwnePitz Crane Co. AMS De La Cruz Boulevard
B Palm Plumbing Co. A14AsN• Hwy 9
By CONTRACTOR,AGENT
245-2323
State License 186579
Approved \_..... _ .. $
PLUMBING INSPECTOR
FIXTURES
NUMBER
MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater
Size
Water Closet
Material
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 & 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 .,1