1757NO. 0 TR T
p P i FOR APPLIANCE PERMIT
s I MAYQ 1964 m
OF CUPERTINO
Y o
R LL
0 a Date 196 Permit No.
3 ° CITY a /
W LL Fee $_l U O
° Application is hereby made to the City of Cupertino for a permit to
o a install gas appliances as listed on the reverse side hereof, and agrees to
ia install said appliances in accordance with the provisions of the Plumbing
= Code of the City of Cupertino, and all other laws applicable thereto.
4 LL Use of Premises
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F; Owner/u-1'eP�L O �@-sr' Address �".(��eria ni4 �n e1i1/34j5
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Z B�5Gr_dresS%Pli�l%/U.so % /1=Y/J
J'O CONTRACTOR, ENT
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a o State License �CkSa 7 Approved
Lu
U PLUMBING INSPECTOR
Type of Appliance
Units Fees II
Remarks (Check ✓;
New Replace Relocate.
Gas Ranges I jj
Wall Heaters
Gas Plates j
Circulating Heaters
Blower Furnaces I I II
I
Gas Fired .Boilers
Warming Ovens I I II
I
Percolators
I I
II
_Griddles
'team Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
I
Miscellaneous
(NAME. TYPE)
d/. w
II I
�,�r✓ I �. o�
II I
_
Appliance Fees /" C-?
Inspected and Approved �jcrv,�lp1rF... ................
DATE. INSPECTOR