1561 %: 9
0Lfl W LOT NO 3S
NO. T }
�l1 PL�IC�r N FOS R APPLIANCE PERMIT
I �0V 8 1963 t OF CUPERTINO
Date N(1V F 1RRR 196..... Permit No.
CITY OF CUPER u iC
Fees /0 106
Application is hereby made to the City of Cupertino for a permit to install
o gas appliances as listed on the reverse side hereof. and agrees to install said
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all
other laws applicable thereto.
Use of Premises
�n Owner ��7,ex�.ae/ If Address �o
By DIVISION Address
HEATING & S CEC Apptov
IsElstltsuwr�oau�a --. t.
PLUMBING INSPHCfOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters I I
Gas Plates I II I I
Circulating Heaters
Blower Furnaces 'P
Gas Fired Boilers
'Warming Ovens
Percolators
� Griddles I I I
Steam Tables
Gravity Furnaces
Suspandecl Unit—Il—
Floor Furnace
II i
Miscellaneous
' (NAME Typr.)
Re4is/eis I/6 •Loo
II I I
p�Fees / uo (�—
Inspected and Approve . . .1(...
TP. INSPECTOR