1782 (2) Tract .#3150
Lor No: Lot•153 . '
NO. eICATI
7R
�® ON OR APPLIANCE PERMIT
6 1964 ; OF CUPERTINO
Date y 6f J� Ipn1pBm
�19G.._4 Permit No.
N Fee S. ,C
o Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing :ode of the City
of Cupertino, and all other laws applicable thereto.
u
Use of Premises Res
0
yl Owner_ Ward Crump Dev. Inc.' _ AddressP• 0• #634
- OS SHEET METAL WORKS, At. ' I Address Cupertino
9 OLD COVW7RN�A
AGENr
tFARLOS, CALIFApproved
I PLUICrBING rNSPECrOR
Remarks (Check ✓)
ape of Appliance Units Fees I New Replace I Relocate
Gas Ranges I 1
Wall Heaters I I 1
Gas Plates
Circulating Heaters
Blower Furnaces 1 1 1 1.0011 x I I
,Gas Fired Boilers 1 1
Warming Ovens 1
Percolators 1 1
Griddles 1
Steam Tables 1 11 1
Gravity Furnaces I I
Suspended Unit 1 I II
Floor Furnace 1 I
I II I
Miscellaneous 1 I
NAME TYPE) 1 1
Fee 1 2.0011 1
10 out 2.5011 I
Htr. Vent I 1 1.0011 1 _
Water Htr vent 1 ( 1.0011 I
I I 11 I I
' pppliance Fees 1 7.5011 I
Inspected and Approved .. ...7� ....................
DATE. INSPECTOR