892 LOT NO
PLICAcT10 APPLIANCE PERMIT
JUL 24 1961 OF CUPERTINO- nn
Date W(/,nr �illf) DT1111Q96,�j Permit No. %2—
Fees , 00
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reveise side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing r ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
_u
Owner-2DS� le�// fclnlc,i Address !Y
By I P Y Address
CONiaACTOa, AGENT
Phone .;152-S l Approve,
PLUNEING INSPEC
Remarks (Check ✓)
Type of Appliance I Units Fees II New_-IReplace I Relocate
Gas Ranges _ II 1
Wall Heaters 3 3,00116
-Gas Plates
Circulating Heaters
Blower Furnaces I I I I
Gas Fired Boilers
Warming Ovens 1 II I 1
Percolators:. _
Griddles
Steam Tables I I II 1
Gravity Furnaces II_ I
Suspended Unit I 1 II I
Floor Furnace I I II
Mi3cei'ianeous I ii
NAME TYPE)
I I II I
I I II I
I I 1 L--
pp lance —
II Inspected and Approve 7- .... ................•.
DAT: INSPEC R