1479 /D5,175'
No. ame r
fm� l 4 �.
(�APPLI'CATI0' N ;FOR APPLIANCE PERMIT
f�, 12 1963 CITY OF CUPERTINO
Date / 1,59
CITY ,, 1963 . Permit No.
OF CUPER o �—
Fees 7
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 code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises�� t���
e
W Owner Address
$y Address�lyf���/� �
CUNT AGTUa, AGaNT
Phone_ ✓ i- ApproveL� G-Yy
� . � � � PGUMBINf. �NSPBCM
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace I Relocate
Gas Ranges I II I
Wall Heaters I I I
Gas Plates I I II I
. Circulating Heaters I q
Blower Furnaces
..Gas Fired Boilers
Warming Ovens
Percolators I l
Griddles
". Steam Tables
Gravity Furnaces I II I
—Sus�nded Unit
Floor Furnace fill
iscell eous I ii
I (NAME`TYPE) L
.I I II I
I I 11 I I
pp Iance Fees
Inspected and Approved ...........
...:............................................ ......
DATE. INSPECTOR '
1 ,•