890 LOTNO
�JUl4G T��N APPLIANCE PERMIT
CITY OF CUPERTINO
Date 7 V11 ERTIN,�6.ael Permit No. y/�Q�
11 s
Fees —%670
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
V Owner_2U5I Al INFO _ Address �0.. 9" Xi
By t AddressCONTRACTOR, AGENTPhone 4 5.2— 1l4 ApprovePLUIrBIN
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges 11 1
Wall Heaters
Gas Plates-
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables ( ��
Gravity Furnaces
Suspended Unit II _
Floor Furnace
NEW
Miscellaneous
NAME TYPE)
4.0011 1
iPPS's 1 I�—
Inspected and Approved/Z.>a .b�;-. . . ..................
TP. INSPECTOR