1250 �V�/7 I LfJ1LGLdl� .C%//iCir �/� PpLOT NO.113
No.
VhMAY
�PPLI �iT'l Np� FOR APPLIANCE PERMIT
31 1963 LAC
OF CUPERTINO
t U 1^I^ 196,.3 Permit No. Z;'572
�2
MY—UN Fee S , s adv
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 theret
Use of Premises <
Owner ecA4�-- CO _ Address_
B� Address
ONTRACTOR, AceNr
Phone 73 9l— y��3 TAPPr ed
Ot�
N. I..... OR
Remarks (Check ✓)
Type of Appliance Units Fees I New I Replace I Relocate
Gas Ranges I II I I
-Wall Heaters I I
Gas Plates
Circulating Heaters
'Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators I it
Griddles II
Steam Tables
Gravity Furnaces
Slapended Unit II _
Floor Furnace I I
Miscellaneous
NAME TYPE)
I I II I
I i II I
Appliance
Inspected and Approved 1 - ) ............................
DATE INSPECTOR
i