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�r CrN/t!c 7� -Pb LOT NO.
NO. Q 5
j PL A R APPLIANCE PERMIT
tn� IMAR 1 964 OF CUPERTINO
Da� O i, 196--Y Permit No.�
r Fee S o a
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 c':ode of the City
of Cupertino, and all other laws applicable thereto.
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u '?Use of Premises-/'? !
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�n Owner C/ilyK�n-f+�'= !».OYcf Address _
By-/QJ'' d f Address RO. '/?ox 6-1-x
CONTRA OR, nGeNr S ��,,����/iskN
Phone r'N d"G Approved_�dJ�s�L
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates �I
Circulating Heaters
Blower Furnaces
,Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces �-�/
Suspended Unit II t
Floor Furnace
♦ O
Miscellaneous u
(NAME TYPE)
Appliance Fees
Inspected and Approved ....��y ...............................
ATE i INSPECTOR