1759 NO. STREET
„ a 1R0LP
R APPLIANCE PERMIT
a OF CUPERTINO
s !MAY ao 9964
O a Date - ��a 1961 Permit No.
U Y F ll�, PER
= o ('! Rc"t ' 7f �'he'b-� �, Fee$ �� ��
"'� pp ho lis re y�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
i m 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 PremisesG2��j/
00
�
; OwneC Eee e e Sa^J Address04
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.N-ea-�-e� . �.c1IZt� L�.�Address`/d�Q�d /di se f?r�/lire
'fl CONTRACTOR AGENT
3Q
— „ Phone 9(0 7 - a�tf 7
a o State License----
icense D 6 Approved ^>
0 PLUMBING INSPECTOR
_ Remarks (Chedc ✓,
Type of Appliance Units Fees II New I Replace Relocate
Gas Ranges
Wall Heaters �)
Gas Plates
Circulating Heaters
Blower furnacesJill
—��
Gas Fired Boilers
Warming Ovens
ercolators
Griddles
Gravity Furnaces
Suspended Unit r
Floor Furnace
Miscellaneous u
NAME TYPE)
.00
I
PP Bance Fees
Inspected and Approve .0'�!!:!' G .. . .......
.................
DATEIN4PECT00.