1793 ,;Z-� 3 �C �/V ✓ LOT NO.
„ f'DEC
LST� OR APPLIANCE PERMIT
IK 15 1964OF CUPERTINO
0 ,
0 < Date / S 196T/ Permit No.
W" CITY OF CUPERTIM1 Fee $ y
° Application is hereby made to the City of Cupertino for a permit to
o install gas appliances as listed on the reverse side hereof, and agrees to
=N install said appliances in accordance with the provisions of the Plumbing
= Code of the Cit% of C rtino, and all other laws applicable thereto.
LL Use of Premises
o ; Owner / && - -' Address-
0
ddress
? z By !v" L ' g eo Address `3G
!'O ��7cONTRACTOR, AG T
3 Phone--Z,3 G s '5
- „
ao State License « f Approved. � / 4 ,,e-, cam �
_l) PLUMBING INSPECTOR _"')
Remarks (Check ✓,
Type of ApplianceUnits Fees I New Replace I Relocate
Gas Ranges I I
\(/all Heaters I I I ! I
Gas:Plates I I II I
Circulating Heaters I I I
Blower Furnaces III I I
Gas Fired Boilers I I I I
Warming Ovens I I II I I
Percolators
_Griddles
Steam Tables I II I I
Gravity Furnaces I I
Suspended Unit I
Floor Furnace
Miscellaneous
(NAME TYPE)
� I 12.E II I
12= 11
1 I II I
I
pp lance ees
Insp-cted and Approved ,Z"' �c�;.. .
.....................................
DATE INSPECTOR