1365 Z U9 lS Qi LOT No. z
NO. STREET
a ad„
LI�AL&Npp FOR APPLIANCE PERMIT
11l I�CITY OF CUPERTINO
AUG 15 19Si63 �i
Date A11G � 3 1963 196..... Permit No.
CITY OF C! ?ER Fee: Z Q
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 f7ode of the City
of Cupertino, and all other laws applicable thereto.
aUse of Premises t
u
r'li Owner L[. - Address• / . --�-�
By Address
�1. HEATING g SHEET WWWITr, AGEN, Approve
1N'
180 E. Slh'boOekS ^vE C^I;PBEtl.—l_[�� � PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters I II
Gas Plates
Circulating Heaters I I
Blower Furnaces / /.,fc, II
Gas Fired Boilers
Warming.Ovens
Percolators I
Griddles II
Steam Tables II
Gravity Furnaces II
Suspended Unit 1 g6�
Floor Furnace II
I I II I
Miscellaneous I ii
NAME TYPE) I I
/.00 II I
I o I .so II I
zo o I I
I I II I
Appliance Fees
Inspected and Approved ..................
DATE. INSPECTOR