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-R APPLIANCE PERMIT
AY 12 1964 � OF CUPERTINO
5/8/64
Dat 196..... Permit No.�
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co �F CUPERMWNFee; w
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CD 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.
Res.
Use of Premises
u
1Z Owner Duc & Elliot _ Address1408 N. Winchester
San Carlos Sheet Nabi '."etlse Jose
779>V Address
Sa arI $ CaIII Or�Ia TMACTOR, AGENT Approved
nP�ong ' 591-260 PP
PLUMBING INSPECT
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates I
Cirndating Heaters
Blower Furnaces
Gas Fired Boilers I I I
Warming Ovens I`
Percolators
Griddles
Steam Tables
Gravity Furnaces
•4uspended Unit II
Floor Furnace
I II I
Miscellaneous
(NAME TYPE
L•ou I
-kzLas •SII I _
-Fe—e, I
pp lance Fees ��—
Inspected and Approved ...IV........................................
ATF. INSPECTOR