1585 (2) Lor NO. i ot3
NO. 570.887
VDECPPUI`CAT BION FOR APPLIAiVCE PERMIT
9 1963 l�. CITY OF CUPERTINO
Date 4 Dec 1963.. Permit No.cc �� o
CITY OF CUFER-
Fee$�
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 r ode of the City
Y of Cupertino, and all other laws applicable thereto.
H
aUse of Premises R@s
Ward Crump Dev. P.O. Box 634
35 Owner _ Address
los Sht Mtl Wks
S* Car ' Address 779 Old County Rd.
CONTRACTOR, AGENT
Phone 591-2605 Approved
�I. I PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I New 1 Replace 1 Relocate
Gas Ranges II 1 1
Wall Heaters 1 I 1
Gas Plates II i I
Circulating Heaters 1 I I 1
Blower Furnaces 1 1i nnll xx 1 1
Gas Fired Boilers I l I 1
Warming Ovens 11 I 1
Percolators
Griddles
Steam Tables 1 1 1
Gravity Furnaces 1 1 11
Suspended Unit 1 _
Flo–or Furnace I 1 II 1
Miscellaneous 1 1
(NAME TYPE) 1
Yee 1 12.0011
,outlet (11) 1 12.7511 1
Comb Vent 1 0011 I _
I i II I
e
pp iance7Approved
Inspected ant:r- �'-- . :. '�.. . 4s. —...........................
DAT. INSPECTOR