1589 ///� / .�, �^'�/�+ ✓ LOT NO. 128
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PPLICATIONtOR APPLIANCE PERMIT
EC 9 1963 Ur1'y OF CUPERTINO
Dat!TV 41PO IDCDT`.�C ,96.63 Permit No.
4fTl�i vv�—�1T'
NFee S7
cc 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 rode of the City
y of Cupertino, and all other laws applicable thereto.
2
V
Use of Premises Res
Ward Crump Dev US P.O. Box 634
V) Owner _ Address____G}per-tlno____
,Pan Carlos Sht Mtl Address 7 79 03 _
CONTRACTOR, ACENr /�
Phone 5, l _9605 Approved PLUMBING INSPECTOR Q•C
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces 1.00 �� x
Gas Fired Boilers
Warming Ovens
Percolators
(;riddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous
NAME TYPE)
Fee 1 12.0011 1
Outlets 11 2.75,1
'Comb Vents _
I
pp lance Fees ,7
Inspected and Approved .. .. .....:`�a� "............
ATF �/INSPECTOR