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LOT NO.___� _
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ST
APPL'ICATIONFOR APPLIANCE PERMIT
' "�C 7 1963 �_c;rr OF CUPERTINO
Dated/ L � / Y..,.__ , 196a Permit No. //�
cs— Cl i'Y OF CIIPER Pee : 5�
V Application is hereby made to the City of Cupertino for a permit o install
gas appliances as listed on the reverse side hereof, and agrees to install said
`Zt appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
aXUse of Premis
AA Owner /a-0 � _ (Address ;?7'S Gt.l
By / w \Address
cON R, AGENT
�L
Phone �4C SZ G Approved
2 PLUMBING INSPECTOR J
Remarks (Check d)
Type of Appliance Units Fees I New I Replace Relocate
Gas Ranges I I
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces f I ✓
Gas Fired Boilers
Warming Ovens I I
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit I II
Floor Furnace T
I II I
Miscellaneous 1 1 1
NAME TYPE)
c C,f 'N 125?) II 1
) Ct 41*r 11
Ix.06 II
I �Y, y-ol
Appliance
Inspected and Approved z; A.!. . ....._.....UAVV..........._...._.......
....
.....
TP. INSPECTOR