1556 LOT NO.
NO. STRB
FOR APPLIAWCE PERMIT
GMY OF CUPERTINO
Mayya I QCT Q 1963 �''.
Date VJ .6 196..... Permit No.
CITY OF CUPERTNO Fee $ 0 0
n1 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 r'-ode of the City
�YY of Cupertino, and all other
laws applicable thereto.
VUseofPremises W
Cn Owner ! "Cn-~�S Address
H..4 cic� A - -
�y�
Add[e5s
CONTRACT-OgE, AGENT.
Phone Approved .,,2.
f+J I PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees II New I Replace I Relocate
Gas Ranges II
Wall Heaters I I I
Gas Plates I II I
' Circulating Heaters I I I I
Blower Furnaces
Gas Fired Boilers I
Warming Ovens
Percolators
Griddles I 11 I
!Steam Tables I II I
.Gravity Furnaces
Suspended Un-17
Floor Furnace•
a e
Miscellaneo �I I
(NAME T E) I II
JVY ML-
I I II I
I ti��eol
pp lance Fees
Inspected and Approved .......�! .-',. .............................
DATE INSPECTOR
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