1679 (2)LOT NO.
} APPLIANCE PERMIT
11 tMAR 111964 &, ' OF CUPERTINO
DatT'{1 !'196..... Permit No.
Fee E
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 of laws applicable thereto.
Use of Premises
Address
Address
Approved
PLUNa1NO INSPECTOR
Type of Appliance Units Fees
Remarks (Check ✓)
I New Replace Relocate
Gas .Ranges
Wall Heaters
I I
Gas Plates I
II I
Circulating Heaters I
II I I
Blower Furnaces I
Gas Fired Boilers
Warming Ovens
Percolators
Il I
Griddles
Steam Tables I
I
Gravity Furnaces I
II I
Susptnded Unit
II
Floor Furnace
_
I
II I
Miscellaneous
(NAMA TYPE)
I/6 I SII
I
I Y I BO
II I
pp lance Fees
Inspected and A rove i...nA E , J.....L,e . —......
P PP `� -
INSPECTOR