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1565 LOT No. NO. 'ET �APA 1 ATS O FOR APPLIANCE PERMIT © CIfl1 OF CUPERTINO N �y/ 9 463 � �Date �/ � I96� Permit No. /c � CITY. QF CUPERT 'K'"� 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 slid appliances in accordance with the provisions of the Plumbing rode of the City �3 of Cupertino, and all other laws applicable thereto. uUse of Premises �.P�2c—sCrti�c . ti Ownerl/�/�'�Dc/ �� Address' Byl Address Q � .-C— 73 ON�A�2 AGENT Approved n Phone f PLUMBING INSPECTOR _ Remarks (Check ✓) Type of Appliance Units Fees II New Replace Relocate Gas Ranges II Wall Heaters I I Gas Plates I II Circulating Heaters II Blower Furnaces ✓I Gas Fired Boilers I II Warming Ovens Percolators it Griddles II Steam Tables I II I Gravity Furnaces 'Suspended Unit Floor Furnace I I Miscellaneous NAME TYPE) � �I i 3 loll I I I II I I I .o�ll I I I II I a Appliance ees Inspected and Approved ............................. DATE. INSPECTOR