1686 LOT NO.
NO. STREET
P I • Ni'FOR APPLIANCE PERMIT
N
� OF CUPERTINO
/MAR 26 1964
Date
—' 196..... Permit No.
CITY OF CUPERTiNO Fee : /6. so
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 bode of the City
of Cupertino, and all other laws applicable thereto.
Use ofPre 'ses
V
r7 Owne L. _ Address_
B / Address
CONT3ACTOR, AGENT
�I.XJ Phone_—&0' S� Approve • �PLUMBINGINSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters I ��
Blower Furnaces 6
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II _
Floor Furnace
Miscellaneous
NAMETYPE)
Appliance Fees
Inspected and Approved ................
D TF. INSPECTOR