1762 t
LOT NO.
?MAY
FS E
OR APPLIANCE PERMIT
Z 20 1964 � OF CUPERTINO
s0 C
O
0 / v
Q _
0 a D7tg 196 Permit No.
3u GITY OF CPU*
Fee-$
0 Application is hereby made to the City of Cupertino for a permit to
o F install gas appliances as listed on the reverse side hereof, and agrees to
<N install said appliances in accordance with the provisions of the Plumbing
= Code of the City of Cupertino, and all other laws applicable thereto.
n Use of Premises
00
�5 3 Ownees-�A�L 5, > AddreSY—I!l
?zsy'p���l dressy-,",F>��Lb�ce
!'O C NTRACTOR, A DTr �T_
— WWW Phone fir/ — y7
e s State License of0 — Approved
ao
U PLUMBING INSPECT
i�
Remarks (Check ✓;
Type of Appliance Units Fees I New Replace I Relocate
^as Ranges I 1
wi-I Heaters
Gas Plates
Circulating Heaters 1
Blower Furnaces I I II 1
Gas Fired Boilers
Warming Ovens 1 II I I
Percolators I I I
Griddles
Steam Tables I'
Gravity Furnaces
�
pen ea d Unit li _
Floor Furnace
II
Miscellaneous I I I
(NAME TYPE
1 A2. (w� II 1
�. I kem II I _
� I
pp lance ees /(4 6011
Inspected and Approved ...:o�' ^;..... . ..................................
DATE. INSPECTOR