1300 Q • d LIST No.' C�NO.
a7aBEY i .
D))) UCAT"1 N CR APPLIANCE PERMIT
J JUN 24 1963q7-,OF CUPERTMO
Date �% _ 162. Permit No. �dC.i
OF %+;,,'K -•
Fee,f /
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 call other laws applicable thereto.
8 Use of Premises /t P �i _. /rr
co Owne Address °
By CON-IMIACTOR, AGE Address
Phone _ APPS' 4
i PLUMBING rNSPBCfOa �,
Remarks (Check ✓)
Type of Appliance I Units Fees II New Rep ace Relocate
Gas Ranges
\Nall Heaters I'
Gas Plates I f'-
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I i •IT `?" I
Warming Ovens I I OL
OL
Percolators
Steam Tables
Gravity Furnaces I {"
Suspended Unit
.. Floor Furnace ' ,' t
Miscellanmus I
(NAME TYPE
i II I
PP lance F— eek
Inspected and Approved0.7''.. . INSPECTOR'.................DATE
CTOR'
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