1679 ���•� LOT NO. V/
M Q iAH T
A APPLICATION R APPLIANCE PERMIT
q MAR 111964 OF CUPERTINO
aDat T' t !'196..... Permit No.
Fee E
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 of laws applicable thereto.
u
Use of Premises
y
Own� Address
By Address
TR a,�ny�Nr
Phone c �1�5` ! Approved
y P'um"'O INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas .Ranges
\Y/all Heaters I
Gas Plates I II I
Circulating Heaters I II I I
Blower Furnaces I
Gas Fired Boilers
Warming Ovens
Percolators Il I
Griddles
Steam Tables I I
Gravity Furnaces I II I
Susptnded Unit II _
Floor Furnace
I II I
Miscellaneous
(NAMA TYPE)
I /6 I SII I
I Y I BO II I
pp lance Fees
P PP A,,-. ..........................
Ins
Inspected and A rove
I./.. . .. . . ,. '. .. ..
DA E INSPECTOR
1