1419 40671 O
V'AUG
IO PIFOR APPLIANCE PERMIT
27 1963 UTY OF CUPERTINO
Da/t+e — 196 3 Permit No. /9_
ii� 1 1- Fee= (o•
Application is hereby nude 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.
u
u �
Use of Premises
s y'6a ad2
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Own .��� _ Address
By Address t�
NTaACTOR, AGENT / c
Phone 73/� y�Z� Approve G
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace I Relocate
Gas Ranges I II I I
Wall Heaters I
Gas Plates I II
Circulating Heaters _ II I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens I II
Percolators
Griddles II
Steam Tables
Gravity Furnaces II I I
3uspehded Ulllt
Floor Furnace
Miscellaneous' ail
(NAME TYPE
> II
I I II I
1 1-2—tH _
pp lance-Fees
Inspected and Approved'Q .Z�( ... -........•..-
p P. INSPECTOR