1700 o� i T
LOT NO.
NO. BG
?" L CAT NFQR APPLIANCE PERMIT
�APR 22 1964 t OF CUPERTINO
Date ;1196..... Permit No. / O O _
(;11Y OF CUPERT
Fee S o0
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.
c ��
Use of�Premisgb /70�u S
ti nd O err�l • LJGAddress _
By ddresses yrS r
CONTRRnCTOa, AGENP
Phone Fi - - o Zz Approved `
N PLUMBING INSPBCTO
Remarks (Cleo[ ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
)1Varming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
Q
Appliance Fees
Inspected and Approved
DA F. .i�..............INSPECTOR**