1587 //,/Y/ NVQ •_" LOT NO. '129
NO. STREET
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APPLICAT10IINI AOR APPLIANCE PERMIT
1_)EG 9 1963 �CIlY OF CUPERTINO /
Date 4 DEC 196...3 Permit No. „�7
CITY of CUPIERT`
tb Fee $ v '�✓
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Application is hereby made to the City of Cupertino for a permit to install
gas appliances ai listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
u
C
Use of Premises RP 9
Ward Crump Dev P.O. Box 634
v, Owner _ Address _
San Carlos S M W�
ByAddress_779 Old County Rd.
CONTRACTOR, AGENT S. C.
Phone_591-2605 Approved
PLUMBING INSPECTOR
Remarks (Check T)
—
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges I
_Wall Heaters I
Gas Plates II
Circulating Heaters
Blower Furnaces 111.Odl x I I
Gaz Fired Boilers I I
Warming Ovens I I II 1 I
Percolators
Griddles 1 1 11 I 1
Steam Tables I 1
Gravity Furnaces I 1 I
Suspended Unit I _
Floor Furnace 1 1 11 I
I I II I
Miscellaneous 1 I ii 1
(NAME TYPE)
Fee I I
Outlets (13T-1111-3--21 I
Comb vent Ir�•Ogl I _
I i II I
pp lance Fees
Inspected and Approved . _l.v- 1.......:4'.�"'_..........................
DA / INSPECTOR