1624 NO.
STaHBT '
APPLICATION IFIOR APPLIANCE PERMIT
FEB 17 9964 S / OF CUPERTINO
Date -7- `�, 196..... Permit No./-
CITY OFC PERT"" Fee s /� 01,
y 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 bode of the City
of Cupertino, and all
other laws applicable thereto.
� � � DUseofPremisesS Rl egy pCl/
Q Q i 6--� L/"VC r/
V) ner�UA U 42I S c4 _ Address L L/—,4 N
Address
c0l,rnkACTO�}- AGENT
(` 2�Phone (G — J 7 'ZAPProve r+
P PLUMBING INSPZCW
Remarks (Check ✓)
Type of Appliance Units Fees New Replace I Relocate
Gas Ranges I II I I
_Wall Heaters II I
Gas Plates- II I
Circulating Heaters
Blower Furnaces aStll I I
Gas Fired Boilers I
.Warming Ovens
Percolators
,Griddles
Steam Tables I II I I
Gravity Furnaces
Suspended Unit _
_Floor Furnace
DAiscellaneous I ii
(NAME TYPE)
'v I I II I
I I . odl I
I I II I
Appliance Fees —�
Inspected and Approved . . ...._.......................
A P. � INSPECTOR