1774 aa� l toT No.
NO--Kb,BT
PLICATION AOF
APPLIANCE PERMIT
MAY 21 1964cCUPERTINO
Date--CM:� r-PT`.106----- Permit No.
,. Feet O
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
\C` appliances in accordance with the provisions of the Plumbing code of the City
of Cupertino, and all of r laws applicable thereto.
Use of Premises—
Own
remisesOw r Address
By , Address ,
coNranc- rqa, nceNT
n Phone 7 Approvedn P� r
77 PLUMBING INSPE9:OR
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters I
1 Gas Plates I II I
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I II I I
Warming Ovens
Percolators I
Griddles' II
Steam Tables
Gravity Furnaces
Suspended Unit I II
Flo r Furnace
l�C—
Miscellaneous
NAME TYPE
I �II I
Appliance Fees
Inspected and Appro"ved .l-
-..
DATE INSPECTOR