1069 LOT NO.
)� APPLICATION F.OR APPLIANCE PERMIT
DEC 17 1962 ?rY OF CUPERTINO
Oa L y
196--- Permit No.
Fee$
Application is hereby made to the City of Cupertino for a permit to install
'Y 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 laws applicable thereto.
u ,
e
. Use of Premises Aeli9
V) Own r /4_//> Y` Jd �.� Address _✓ ,
Address
o CONTRACTOR, AGE
Phone -1 Z-52 I Approve
PLUMBING INSPECTO
Remarks (Check ✓)
Type of Appliance Units Fees I New I Replace I Relocate
iPercolatomrsl
ges I II
aters I II Iesng Heatersurnaces ., .0011d Boilers Ovens II 1rs 1 I n
Griddles I 11 1
Steam Tables I I_�_ I
Gravity Furnaces 1— 1
Suspended Unit-11
Floor Furnace
Miscellaneous 1
(NAME TYPE)
011I
—
_ II I
pp lance ees
�x
Inspected and Approved ..•.� ..............
DATE INSPECTOR