1656 C� �NO. s � �"S"a�""�
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qPAPPLICATION� IFaOR APPLIANCE PERMIT
CITY OF CUPERTINO
FEB 2 81964 - z
Date FEB 28 1L964 196--... Permit No.
'J.iY OF CUPL Feet o2(, p U-
4 Application is hereby made to the City of Cupertino for a permit to install
egas 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. /�' �
aUse of Premises /L i�� El u'l..
m /
in
Owner1555 _ Addresstif�
B J Address 91 OLIVE. MT. VIEW
ONTRACTOR, AGENT
q Phone 39-4223 Approved
,t' PLUMBING INSPECTOIL-V
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces I I.
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity. Furnaces
Suspended Unit II
Floor Furnace
Miscellaneous n
NAME TYPE)
Appliance Fees
Inspected and Approved ._.._._....:_.' .... .. .......................
DATE. INSPECTOR