1231 LOT NO. f
NO. STE
T11MAY
PPCIC'A'111N -'OR APPLIANCE PERMIT 2 4 1963 OF CUPERTINO
\ Date 196 Permit No.
CITY OF, CUPERTINO Fees `s0dv
L Application 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 said
v appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
:a
of Premises
u ylo O `2rsT slums!Glee,
Address
Owner o
- - --
By
Ownj — Addresslz'-/ nLc Z&I-
CONTRACTOR, A EfY
Phone J — 4/2, 2, 3 Approved
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees I New, Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates � � ��
Cirnilating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators'
;Griddles
Steam Tables,
Gravity Furnaces
7T Suspended Unit II
Floor Furnace
.- Miscellaneous
'(NAME TYPE)
Appliance Fees
Inspected and Approved . ..—`�.c ........................
r DATE. INSPECTOR
Ips .
t