1459 (2) LOT.NO.
NO. STMEBT,
®/ PP
LICAON FORAPPLIANCE PERMIT
Sp c$ OF CUPERTINO
12 1963 �,�Date" �•A/Q —•_�, 1915.3 Permit No.r 9VIii fl,Gl'�6 V � Fee $ 7Applition is hereby made to the City of Cupertino for a permit to install
gas applians as listed on the reverse side hereof, and agrees to install said
appliances accordance with the provisions of the Plumbing bode of the City
of Cuperti , and all other laws applicable thereto.
u
u
Use of Premises A�Z�_-
u
05 Owner Address
By AAddress � 21 ,
Qn p CONTRACTO0., AGEN
!J ' Phone o2?f%�/�� 1 Approved G INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates"
'Circulating,Heaters I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit 'll
Floor Furnace ��
iscell eous:.
' NAME TYPE)
to :�
Appliance' Fees �—
Inspected and Approved J.. .. ,... .1i.. .. .._........__......................:..
DATi / INSPECTOR
w