1701 NO. STREE�TT
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P ' : .R APPLIANCE PERMIT
Fit,
C OF CUPERTINO
I APR 2 9 1964
Date 196..... Permit No.
CITY OF CUPERTHNO Fee : ,,3od
Application is hereby made to the City of Cupertino for a permit to install
K 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.
u
Use of Premises
00
n xbwn _ �<Address
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CONTRACTOR, nceNr
xPhone 0 <—.P Appro�
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I ��
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE I IL
Appliance Fees
Inspected and .............................
D TF. ( INSPECTOR