894 °° t9F
LOT NO �(l
NA C�ICflOMAPPLIANCE PERMIT
t.�' ► JUL 2 4 9962 . CUPERTWO
Date / / l 1 6.=2 Permit No.
Y OF UPERTINU PK: o0
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 c'.ode of the City
of Cupertino, and all other laws applicable thereto.
�C
Use of Pree�miises
�r Owner_ l/fUSS �O)/L lCinlSnnl _ AddressQ 5n RS('�
By�PAY P Address
CONTRACTOR, AGENT
Phone -x U --6 11 4 Approve
� rLus[anvc n+sre a
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces I ��
—Fired Boile—rS
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces'
Suspended Unit
Floor Furnace.
Miscellaneous.
(NAME. TYPO III
Appliance peespp ��
Inspected and Approved .. L?01.7.G', /. . .. . .. ... .........................
pATP. T00.