1790 n /1/
•/`R.l.. A.rw`tJ LOT NO. /J
Q RE�` '
D P i L;F�OR' APPLIANCE PERMIT
Z. ? JUL 9 1964 OF CUPER I{O
10
Y 0
o < Date -�� r��6� Permit No.
3 LLMY OF UPE IItlV Fee $ 9 .To
o Application is hereby made to the City of Cupertino for a permit to
o a install gas appliances as listed on the reverse side hereof, and agrees to
=a install said appliances in accordance with the provisions of the Plumbing
Code of the City of Cupertino, and all other laws applicable thereto.
u z P PP
n Use of PremisesE'S//>E.rI�E'
o_ o p
' "
O3 Owner12FZO GNRS Address/o+/X7 -PH.IR-LAP
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�i BY -r-1,4FA;W"e_ ? Address 7..Ps 1,cwzF_H 4✓P
CONTRACTOR, AGENT
3 < y3-y/,9�
- y Phone ,
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. W
os State License d/,9 Approve
O PLUMBING INSPECTOR
-U�
Remarks (Check ✓,
Type of Appliance Units Feet New Replace Relocate
Gas Ranges
%Xfall Heaters
Gu Plates �I
Circulating Heaters
Plower Furnaces 1
'Gas Fired Boilers
Warming Ovens I P
Percolators
Griddles
Steam Tables
'Gravity Furnaces
Suspended Unit _
Floor .Furnace
Miscellaneous � I u
(NAME TYPE)
' aol
pp lanceeeF s y�D
Inspected and Approved/Qr �,..... ............
DATE. INSPECTOR