1457 (2) 1
NO. STRHHY� COT NO.
�P.LI•CATION F'OR APPLIANCE PERMIT
all
C11 Y OF CUPERTINO
LI'l
/ �/
Date /o 196.3 Permit No: 1Y 5;
CITY OF CUPERTNG Fee s Z �s
Application is hereby made to the City of Cupertino for a permit to install
n 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 lawsapplicablethereto.
Use of Premises 4e6�
u
� Own ! ddress
By Address
1� 1 �I
CONTRACTOR, AGENT 1
JtJ
Phone g27Z.E'�/�'1 Approved
' PLUMBING INSPHCTO
Remarks (Check ✓)
Type of Appliance 1-Units Fees 1I New, Replace I Relocate
Gas Ranges
Wall Heaters I I
Gas Plates
CirculatingHeaters I 11 I I
'Blower Furnaces
Gas'Fired Boilers I
Warming Ovens 111
Percolators
Griddles 1
Steam Tables I II I 1
Gravity Furnaces
Suspended,-Unit 1 I 1
Floor Furnace I II 1
I
Misc• aneous v
(NAME TYPE) I I I
I I II I
I I- 11 1 I I
pp ianccFees I 1 1 y�111,,sp,
inspected and,Approved .-..�.�.. ..-.--- -- --.DATECTOR