1620 (2) T��G
/ Tra ct #3150 1
�771LOT NO. Lot #U2
NO. STREET ,
Poi�Fr APPLIANCE PERMIT
C F CUPERTINO
��S 10 1964 � 4 �30
Date 19G._... Permit No._�__
CITY OF CUPERT�,WQ Fee: --� 5
Application is hereby made to the City of Cupertino for a permit to install
Ngas appliances as listed on the reverse side hereof, and agrees to install said
p appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
u
Use of Premises Res
Ward Gump Dev. Inc.
in Owner Addrm P•C• Box # 634
1 Carls Sht Mtl Wks, Address 779 M County Rd.
�pp'rn nceNr
Phone Approved d
PLUMBING INSPeCTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace Relocate
Gas Ranges
Will Heaters
Gas Plates II
Circulating,Heaters I II I I
Blower Furnaces ill 1.0011 I I
-Gas Fired Boilers
Warming Ovens I I II I
Percolators it
Griddles 1
Steam Tables 11
Gravity Furnaces
Stispended'Unit I II
.,Floor Furnace 1
I II
Miscel'lancous
all
(NAME TYPE)
Fee I 1
13 outletsW..H.. vent I
Ht. vent I l.ogl I
KA
pp lance Fees
Inspected and Approve' °.. . • .- _..... O....._-----_....
DA '
"IsCPETOR