1696 (Q 9 r
/ a� `r�r` L0T NO.
�OR APPLIANCE PERMIT
OF CUPERTINOAPR 20 1964
/
Date — •,r196..... Permit No.Gily OF
Fee $ /5 OC)
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 thereto.
Use of Premises //' _
C% Own `�""r-'''� Address
By u+ �� Addres
ONTRACTOR, Ace
e Phone�y�{�''' p' c/ Approved
PPLUMBING INSPECTOR
Remarks (Check 7)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates II
Circulating Heaters
Blower Furnaces —OU f
Cas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables I�
Graeity Furnaces
Suspended Unit _
Floor Furnace
—If
Miscellaneous
(tJAMTYPE
ig —II
2�1 s— II I
pp lance Fees �
Inspected and Approved .. �.I.g ... ...(........___......._....................
DAT. 1 INSPECTOR