1619 (2) n /� Tract #3150
r1 4 ! r_b>% J'r�� Lot #111
BT, LOT NO.
NO.-
ih
F
LT'tCt lP6%Ne 4 R PPLIANCE PERMIT
C OF CUPERTINO
3 F@@h. �in4
Date GIT .
I1pFR 1,.1W... Permit No.
Fee= 0 y
Go Application is hereby made to the City of Cupertino for a permit to install
C\1 gas appliances as listed on the reverse side hereof, and agrees to install said
0 appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
u
E
Use of Premises Res
Ward Cramp Dev. Inc. P. 0. Boa 6k 634
ig OwnerAddress
Sar YCarlos Sht tftl Wks. Addres779 0 County Rd. S. C.
CONTRACTOR, AG BNT � �
Phone 591-260$ Approve
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges 1 II 1
Wall Heaters I I I 1
Gas Plates
Circulating Heaters I I 1
Blower Furnaces 1 1 11.00 II
Gas Fired Boilers
Warming Ovens 1
Percolators 1 1 11 1 1
Griddles 1
Steam Tables I 1 11 1 1
Gravity Furnaces '
Suspended Unit 1 1 II
Floor Furnace.
I I II I
;Miscellaneous 1 1
(NAME TYPE) I
Fee 1 1 2.0011
xmdz 12 out. 1 13-0011
w.h. vent 1 11.0011 _
. ven 1 11.0011 r
pp lance Fees �—
Inspected and Approved nom. .. .. .........r. .`.......—....._.._........
ATF. INSPECTOR