NO PERMIT NUMBER / LOT NO.
NO. Q T
„ � 1� I RI: FOR AP LI
964
PERMIT
v z t NOV 2 964 + MY OF CUPERTINO
s �
Y 0 ,
o Date 196E/ Permit No.
W n CITY Fee$ J/
�—
` 0 Application is hereby made to the City of Cupertino for a permit to
o install gas an as listed on the reverse side hereof, and agrees to
i a install said appliances in accordance with the provisions of the Plumbing 1
i Code of the City of upertino, and a� othe la._l vs applicable thereto. 1
Use of Premises
00
0 Owner '/� '�'�/� dress loo S
0 AL
? z By 614-wc-,� Lor i�-�-n �`a Address /
CONTRACTOR, AGENT
- h, hone—Wz
Q
o s State License �7 / -� Approve
40 PLUMBING INSPECTO 7
—U
Remarks (Check ✓)
Type of Appliance Units Fees I New I Replace I Relocate
Gas Ranges 1
Wall Heaters 1 I 11 ! I
Gas Plates I II I
Circulating Heaters I I I I
Blower Furnaces 1 I II I 1
Gas Fired Boilers 1 I 11 I I
W21Ming Wiens II
Percolators
Griddles I I 1
Steam Tables I I II I
Gravity Furnaces I 1 II 1 I
Suspended Unit
Floor Furnace 1 I
Miscellaneous 1 I ii 1
(NAME TYPE) I __
I I NII I
(^�- mot r I/ II I
6LApp lance Fees Ifj-]I �
Inspected and Approved ............ ..
DATE. INSPECTOR