1653 �J ✓ 6K�N LOT NO. — 3
NO. Q`5 8T%` _
iAPPLICATION FO APPLIANCE PERMIT
FEB 2 8 196^ CITY OF CUPERTINO
FEB ? 81864- �s3
Date -- _— � r+" ' ' , 19G_... Permit No.
! a t Ur V�IT"R
Fee 2O JD
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
�i appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
Use ofPremises
�
�� l
Address
B Address 81 ALICE AVE., MT. VIEW
UNTRACTOR, AGENT
Phone 139.4223 Approved
PLUMBING "SPecTOR
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces _l
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit T
Floor Furnace
Miscellaneous u
/NAME TYPE)
Appliance Fees 30•S
Inspected and Approved ..............:... .........:....................................
DATE. INSPECTOR