1758 D NOS
m d Rj{$L OR APPLIANCE PERMIT
_ -
OF CUPERTINO
' o !MAY 20 1964
0 U Date— 196—e`/ Permit No.
CITY OF CUPERTM) Fee $ / 0 U
' 0 Application is hereby made to the City of Cupertino for a permit to
o install gas appliances as listed on the reverse side hereof, and agrees to
<m install said appliances in accordance with the provisions of the Plumbing
„ = Code of the City of Cupertino, and all other laws applicable thereto.
Use of Premises
00
OwnerYe eLL'Y�.rl Addres
__j r � 7� g�o
� z B �c/%ham i•>c� a o Address n
:1'
'0 CONTRACTOR, AGENT
— 9/7
m Phone
o s State LicenseApproved
a 0 TUU PLUMBING INSPECTOR
Remarks (Check ✓,
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
as Plates
Circulating Heaters —�
Blower Furnaces
Gas Fired Boilers
�Warming Ovens
percolators -
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace 1 11
Miscellaneous _� u
(NAME TYPE I 11
00
I
Appliance Fees _
Inspected and Approved P:17-0 ...... . ................................
i
DATE INSPECTOR