1687 2 J 7/ T P✓T/YJ �/ z ✓-OT NO.
VC sTa ET
V05AkPPLICATIU� A:� APPLIANCE PERMIT
AR 2 B 1964 OF CUPERTINO
Date t / v 196_y Permit No. 6 6
N l� IN
Fee S ✓
G Application is hereby made to the City of Cupertino for a permit to install
h gas appliances as listed on the reverse side hereof, and agrees to install said
1 appliances in accordance with the provisions of the Plumbing code of the City
rl of Cupertino, and all other laws applicable thereto.
a
aUse of Premises
/ DD 1
r
Owner 7/ e L O Ll/�/.p,Q Address--)-
gy/"/bN fg U/S�/A ���`) Address
CONTBACTOa, AGENT
Phone 2 S-7 133 7 Approved
O n PLUMBING INSPECT
1l YV1 1
Remarks (Check ;7)
—
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators jl
Griddles
Steam Tales
Gravity Furnaces I I I�
Suspended Unit II
Flo r Furnace � ��
Miscellaneou
(NAME TYPE)
7
Appliance Fees (—
Inspected and Approveb ./. -----
D F. [/ IN eTOa"
P