1616 LOT NO.
No. ® TRB
® PLIC'ATI'CNOR APPLIANCE PERMIT
JAN 311964 OF CUPERTINO
Date u 1 . . 196.; Permit No.
tK ..'. : Fee S�
c� Application is hereby made to the City of Cupertino for a permit o 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, a d all other laws applicable thereto.
Use of Premises
�i
Owner— f'+•�vx�, ��..,i _ Address _
By"�c+,` 0% e,• Address J
COMB TORAC AGHNT
Phone 3.2 X 47 Approved '
I N PLUMBING INSPEcrOR
Remarks (Check ✓)
Type of Appliance Units Fees II New I Replace Relocate
Gas Ranges I I
Wall Heaters I
Gas Plates
Circulating Heaters
Blower Furnaces /,DD
Gas Fired Boilers
Warming Ovens
Percolators II_
Griddles II
Steam Tables I
Gravity Furnaces I I
Suspended Unit
Floor Furnace
17,oill
Miscellaneous
NAME TYPE)
I oll I
I I II I
pp ;ance Fees
Inspected and Approved �.. _r... ... _..._............... ......_...
D TF. INSPECTOR