1605 DD
/D LOT NO.
NO. SIRE
04 PP ICATIN fOR APPLIANCE PERMIT
(JAN ' D 1964 ICfTY OF CUPERTINO
Datc
/ /
' —C 196.4. Permit No.
Fee $C4, O
(� Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said 1
appliances in accordance with the provisions of the Plumbing rodc of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
7 Owner 4 _ Addr
6
By��Qet.� Address✓1.- �7.
CONTRACTOR, AGPT Phone Approve
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees II New Replace Relocat
Gas Ranges I�
Wall Heaters
Gu Plates II
Circulating Heaters
Blower Furnaces ,v0
Gas Fired,Boilers II
Warming Ovens
Percolators fl
Griddles I�
Steam Tables
Gravity Furnaces _
Suspended Unit �—
p Floor Furnace -�
Miscellaneous i t
NAME TYPE) I -
� � • vall I
Appliance Fees oa —�
Inspected and Approved . \:1 .... ................_.............._...:
TF. �' INSPECTOR
ADD'ITION'AL CHARGE
I ppR 1964 Y OF CUPERTINO
~r BUILDING INSPECTOR'S OFFICE.
v / y/
�I51._..., 19 6Y Permit No.
it
U1 11r V ..D�../..
To It
Address �Q ..C�.....-- ` '- - ............. -
�- ...................
Reason Y.....
Amount$ ..6.--- -- _ Signed .. ... _ .....%!Y- ....---......................_.
2 106 3/59-3011