1702 LOT NO.
NO. STREET
® "�f A70WI,FOR APPLIANCE PERMIT
LLCITY OF CUPERTINO
MAY a 1964 WW
Date 196..... Permit No. 1 U
CITY OF CUPERP't2 Fee r
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
of Cupertino, and all oth laws applicable thereto.
c / �
Use of Premises
0Owner - ._ Address
Br- ays A Address J 3 J�-7
�_NT ACTOR, AGENTAGENr
Phon Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters I ��
Blower Furnaces
-Cas Fired Boilers I --
Warming Ovens
Percolators j
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
Miscellaneous u
(NAME TYPE)
l cfd
Appliance Fees
Inspected and Approved ...1. .... ..: .. . ( ._....---..............._...
DA INSPECTOR