1560 "tAA At- LOT NO. 34
NO. S HT
IFIFOR APPLIANCE PERMIT
-tCYI'TY OF CUPERTtNO
D1/� 8 1963 /
Date NOV 6 136? 196__._ Permit No. Z-5 v
CITY OF CUPERT'".':" Fees X0100
Application is hereby made to the City of Cupertino for a permit to install
p gas appliances as listed on the reverse side hereof, and agrees to install slid
appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premmiiisses oC
_ r Owner z,/ -0- - K J Aon J Address
DMStON
ByHEAPNG & €Ida&9A'�! A Address
11 6 NNYMUS AVE., CAMPSYLL, CALIF, i Approv
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I New I Replace I Relocate
Gas Ranges II I
Wall Heaters I I
Gas Plates I
Circulating Heaters
Blower Furna
Warming Ovens I II I I
ces Z 2.00 I I I
Gas Fired Boilers II I
I I I I
Percolators
` Griddles
Steam Tables I II I
Gravity Furnaces
Sttspended Unit—��—I
Floor Furnace
I I
Miscellaneous I I
(NAME TYPE) I v
F/was I z I zoo II
I /61 � o011
p � I 2.00I I
I II —i
pp lance •ees of
Inspected and Approve n �'
} ., �...... .. .................................
'pA INSPRCTOR