1397 LOT NO v /
�NO.
APPLICATION1 FOR APPLIANCE PERMIT
AUG 2 7 1963 ,���`!carr of CUPERTINO
(Dater nr0"lnr 196-3 Permit No. 3
Fee i
NilApplication is hereby made to the City of Cupertino for a permit to install
V gas appliances as listed on the reverse side hereof, and agrees to install siid:.
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
u / d �'
Address Gala/'
—�
B Address
Acroa, AGExr
Phone Approve 1i 2
PLUNGING IN5P8CTOit
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates I ��
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators jl
Griddles
Steam Table:;
Gravity Furnaces
Suspendgd Unit—� jl i r
Floor Furnace
Miscellaneous;
AME TYPE)
a
Appliance Fees
KA
Inspected and Approved t ........................
TP. INSPECTOR