1366 2a3 oS L� Lm No. 2-9
No. �srxeer
PL'IC�ATION FOR APPLIANCE PERMIT
tom ! AUG 15 1963, 1. CITY of CUPERTINO
Date AUG 1 3 1963 196..... Permit No.
CITY OF CU?ERT �'�
Fee :�
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 other laws applicable thereto.
u
C '
Use of Premises
u 7�
4i Owner k- Address
LNG
Address
HEASHEET GUNr7l.+cM" AGPNT m[��� U Approved180 E. SKS R9E.. EkIAPBf�k, ERHf, wY6INc INsracroa
Remarks (Check ✓)
Type of Appliance Units Fees I New I Replace Relocate
Gas Ranges I
Wall Heaters I II I I
Gas Plates II
Circulating Heaters II I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
II I
Miscellaneous o
(NAME TYPE)
/--o
7.2s-
Appliance
II
I .z pp lance Fees 6.74—
Inspected and Approved ...............
DATE. INSPECTOR