1555 LOT NO.
NO ® TR
�PPLICATIONIIR APPLIANCE PERMIT
o .,a 1 t1CT 2 9 1963 OF CUPERTINO
MIL �
V h Dat
U
r nis 196..... Permit No.L _s
Aa2da
1� Fee E 0 O
n Application is hereby made to the City of Cupertino for a permit 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.
e
Use of Premises (Q7
W) Owner Address
By �t a r�O Address
Crl DNTRACTOR, AGENT �
Phone ��� i Approve Festa-VL.
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace I Relocate
Gas Ranges I I II I I
Wall Heaters I I I I
Gas Plates I l I I
Circulating Heaters I I__ I I I
-Blower Furnaces 7' .OGtll
.Gas Fired Boilers' I
>Warming Ovens I I I I
Percolators I I I
Griddles I I
Steam Tables I II i
Gravity Furnaces
Suspended Unit I I II_
Floor Furnace _
4.L- u0
Miscellaneou �I
(NAME. TY f..% fiII Il
— ;— T 1 OQIII ll
I II
i I I II I
I axil I I
pp lance pees I hl
Inspected and Approved ... .�... ..
PATE INSPECTOR
¥ 2 \ / . 4
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