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1763 / �V V LOT NO. 0.VA 14 PLIC FOR APPLIANCE PERMIT W z (MAY 2 0 1964 OF CUPERTINO IMO W , Y a l�ep�__,Cy� 196 Permit No. W , 1 1 U( �J�'t��((�� '��uJ Fee$ . ' 0 Application is hereby made to the City of Cupertino for a permit to Oa 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 W = Code of the City of Cupertino, and all other laws applicable thereto. Use of Premises _ Gt'� 00 ' " � Owneot�✓OPLL foicl y�� S Addres Y4Af. i29 c / ZJ _ Jo gp O 2��>�/7 T oAddres , moo JX� �kY . CONTRACTO �ln.Te $1/ , AGENT a Phone N / ao State Licenseaa 5 —v Approved �f _U PLUMBING INSPECTOR y Remarks (Check ✓, Type of Appliance Units Fees II New I Replace I Relocate Gas Ranges Wall Heaters Gas.Plates I I 11 CircWating Heaters Blower Furnaces Gas Fired Boilers I I I _ Watming Ovens I II I I Percolators I I I Griddles I II I Steam Tables I I 11 Gravity Furnaces I I I I (-- Suspended Unit I I l� � Floor Furnace Miscellaneous , (NAME TYPE) II I p� ees r i Inspected and Approve da..- . i 3..;...... .................................. DATP. INSPECTOR _ { { � � « � § \ ( \ _ ; � \ \ 2g rn IT, o 0 } \ \ ^ © � � � 61 � � \ / � � ` .m I.z > O / o ? O H w T W N � C N ('q a n V1 For ° m nMn M � m Z i . 00 --1 czi o o � � ?• " n E T rri m n : 2 H : 1 o°