893 16141 LOT NO. I I
NO. Q
® PLICA Iik.
R APPLIANCE PERMIT
JUL 24 1962OF CUPERTINO
C� 196.,,2. Permit No. —
7� Fees DO
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 other laws applicable thereto.
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Use of Premises
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Owner (.1)1 L k 10).!WA) _ Address - _/IezicQ
By �40 6P,19-1 P r A11106 Address 2_�2 n 141zily q
CONTRACTOR, AGeNr
Phone ,2 - //1/F APProv
PLUMSIN ENSP
Remarks (Check ✓)
Type of Appliance—I Units Fees II New I Replace—IRelocate
Gas Ranges j I
Wall Heaters
Gas Plates I II
Circulating Heaters I I II I I
Blower Furnaces
II
Gas Fired Boilers
I I II
Warming Ovens I I II I 1
Percolators
Griddles I II
Steam Tables I I 11 I I
Gravity Furnaces _ I
Suspended Unit
Floor Furnace
Misce.laneous
NAME TYPE)
��00II I , oo 11 I
I II i
I II —
pp lance ns ,C I I
Inspected and Appro"vedr. . ...... ..............
DAT INSPECTOR