1364 2 0 3.7-F
,. LOT NO. 27
NO. cSTREET
P�ICATI�eNI FOR APPLIANCE PERMIT
� CITY OF CUPERTINO
L� ' AUtr,� 15 1963
Date HGG 1 H 19 196..... Permit No.
UTY OF Cl1?ERT'' Fee r
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
g of Cupertino, and all other'laws applicable thereto.
2
aUse of Premises_
u
W Owner Address
1t� Hy Address
H TIN ACTOR, AGENT -
& SHEET METAL CO. Approved
ISO E. IQI{FI$�{Y�. t`A 1L�)� CALIE� PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters I ��
Gas Plates j
Circulating Heaters
Blower Furnaces
•Gas Fired Boilers ( ��
Warming Ovens
Percolators I�
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
Miscellaneous
/NAME TYPE)
2:2.1
Appliance
Inspected and Approved ..............:... ..............................................
DATE INSPECTOR