1553 RR LOT NO.
®APPLICATION ICOR APPLIANCE PERMIT
4 0 M2 2 9 1963 IC OF CUPERTINO
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V v Data Q r I r-m-r— •n 196..... Permit No.
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Fee$ d
Application is hereby made to the City of Cupertino for a pe.rmit to install
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 Prrmises - .�/ {� /
W OwnerU�--- �-N'a+---- Address& 7 L i`4-P A
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Ips Phone Approve
r/ PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance—1 Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Ga Plates
Circulating Heaters
Blower Furnaces ,'Z .0
,Gas Fired Boilers
WOarmi gvens
,Percolators
Griddles
Steam Tables
Gravity Furnaces
'Suspended Unit _
Floor Furnace
Miscellaneous
(NAME TYPE
0
PI) lance Fees
Inspected and Approved.7- Be.. ........ ...........................
DA P. INSPECTOR
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