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w I'll, I l ✓ LOT TIOy�`
NO. Q F.E
CfnF,OR PLUMBING PERMIT
TfIMPY 131Ti YJIJF CUPERTINO
131968
Sanitary No.
Date 6 14(1/ Permit No
TTY 0 �U I R 1 Ii�llFee $
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
Ditz Crane Co
Dwelling
WDe La Curz Boulevard
By Palm Plumbing Co. ��d�i�s Hwy 9
CONTRACTOR,AGENT
Phone 245-2323
State License lt4FiK70 Approved WILLIAM D. BENEVIr."
x PLUMBING INSPECTOR (/
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES UNITS FEES
Shower/
To Pro .Line ✓
Lavatories
To Fxistin
Kitchen Sink /
Not Conn.
Dish Washer
Sewer Box
Waste Disposal
TOTAL FEES
Wash Tray
STORM DRAINAGE
Washing Machine /
Size
Comb.Sink & Tray I 1 11 To Curb
Fountain
Moor Drain
WATER SYSTEM
Hopper
Size
Restaurant Sink
Material
Send Trap
TOTAL FEES
Urinal
Fixture Fee
Area Drain
Main Drain Fee
Water Leader
Storm Drain Fee
S rinkler Valve
Water a. Fee /
Relief Valve
Gas Fee
Filter
Permit Ne
Total Fee