1416 aoG 7s yup- LOT NO ✓ G
NO. .� �sTRBRT•`
APPLICATION+ FOR APPLIANCE PERMIT
AUG 277, 1963 � 'CII1r OF CUPERTINO
e• . ran i��+:�n 196-3- Permit No.
Fees 7-
Application
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 lawsapplicablethereto.
l
c A
Use of Premises � p�
,A Owner�� _ Address
By7 Address — Y
O ACTOR, AGENT l
A Phone r7 9- y 2- Z3 Approv LL ? .
•'✓ I PLUMBING MSPRCrOR
Remarks (Check ✓) I
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens � � ��
Percolators
Criddles
Steam Tables
'Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous /
(NAME TYPE) I&13,0611
& �
pp lance l:<:es
Inspected and Approved ... .... ...... ..',. . .......
ATE INSPECTOR