1651 w�+R�LOT NO.
NO.r ST0.E
1.
� A1 PPLICATIONS F APPLIANCE PERMIT
'FEB 2 8 1964 ,CITY OF CUPERTINO
Date FEB 28 1964 196..... Permit No.
G, 1 t Ur UWtK
Fee t
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 Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
i /�
7 OwneQG / � 35C _ Address.
Ey?!1s ' Address 81 ALICE AVE., MT. VIEW
CONTRACTOR, AGENT
Phone 739.4223 ` Approved
y/ PLUMBING INSPECTOR
J� I%
Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters I ��
Blower Furnaces
Gas Fired Boilers
,Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II11
Floor Furnace
Miscellaneous n .
NAME TYPE)
Appliance Fees \
Inspected and A rove
Pp per.. . \\ .......`. ...�....... R................
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