NO PERMIT NUMBER (2) ° No. Street Lot No.
o —
N
d APPLICATIpNFF R P,L�M sBli�'„G E 1
CITY"b (NPEPfNO �
' yfill
h (OCT 31s451MY N .
.G
Y Date October 28, 1968196_ Permit No.
CITY OF CUPERTINO Fee S c S-Z)
3
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.
° Dwelling
14 'a Use of Premises
oDitz Crane Company 22?5 De La Cruz Boulevard
Owner Ad ress
Palm Plumbing Company 1231 Sw ale�aratoga Rd.
N
By Address
3 sem. Contractor,Agent
v ° Phone 2452.323
_ti3V:CF
6
/ State License 18579 � Approved ✓
Plumbing Inspector
FIXTURES INUMBER MAIN DRAIN
Units I Fees I Units Fees
Water Heater / Size
Water Closet Material _
Bath Tub To Curb
Shower To Prop. Line tr
Lavatories 13 To Existing
Kitchen Sink Not Conn.
Dish Washer
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 C
Water Leader Storm Drain Fee
Sprinkler System Water Sys.Fee
Relief Valve cas Fee
Vac Breaker
Skimmer
Filter
Permit Fee --Z
Total / Total Fee c, SU