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1763 / �V V LOT NO.
0.VA 14
PLIC FOR APPLIANCE PERMIT
W z (MAY 2 0 1964 OF CUPERTINO
IMO
W ,
Y
a l�ep�__,Cy� 196 Permit No.
W , 1 1 U( �J�'t��((�� ���'���uJ Fee$ .
' 0 Application is hereby made to the City of Cupertino for a permit to
Oa install gas appliances as listed on the reverse side hereof, and agrees to
`N install said appliances in accordance with the provisions of the Plumbing
W = Code of the City of Cupertino, and all other laws applicable thereto.
Use of Premises _ Gt'�
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CONTRACTO �ln.Te $1/
, AGENT
a Phone
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ao State Licenseaa 5 —v Approved �f
_U PLUMBING INSPECTOR
y
Remarks (Check ✓,
Type of Appliance Units Fees II New I Replace I Relocate
Gas Ranges
Wall Heaters
Gas.Plates I I 11
CircWating Heaters
Blower Furnaces
Gas Fired Boilers I I I _
Watming Ovens I II I I
Percolators I I I
Griddles I II I
Steam Tables I I 11
Gravity Furnaces I I I I (--
Suspended Unit I I l� �
Floor Furnace
Miscellaneous
, (NAME TYPE)
II I
p� ees r
i
Inspected and Approve da..- . i 3..;...... ..................................
DATP. INSPECTOR
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