1601- ;�-- LOT NO. -
NO. 371887
{#'- OR APPLIANCE PERMIT
F CUPERnNO
r1j" N 15 9954
Hare 196..... Permit No. / 6J
CITY OF CUPERTINO Fee: �5
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 slid
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
iop?
Use of Premises i�^
Y'Owner_PAUL W' E'S6IeV%6-ue`r-Address Cc,� ��q r I-lm
�Y Address 3 r (t
CO ACTOR, AGENT
* 4 �Phone 78 Z Approved
�lJ PLUMEP7G nV3P8CTB
Remarks (Check ✓)
Type of Appliance Units Fees I New ( Replace R_elocat
Gas Ranges II
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens I�
Percolators
_ riddles
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
I
(NAME-TYPE) -
pplance Fees a
Inspected and Approve��...�.,...
DATE. INSPECTOR