1429 J940 Wood �, LOT NO. Z
NO. STRBRT
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Date ' 14P 196� Permit No. ` a _
.R Fees O �
(� Application is hereby made to the City of Cupertino for a permit to install
((D 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
�(P of Cupertino, and all other laws applicable thereto.
Use of Premises
r7i Owng/ I SI d(e LOYJS't r_ Addr& -4"F2t�-
By Address 1b R % 7)
CONTRACTOR, AGBNT �
Phone _ _ /ZO.9 Approved -C Gv
PLUMBING INSPBCTO
T
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters avir
Gas Plates
Ciroilating Heaters
Blower Furnaces
Gas Fired- Boilers
Warming Ovens
p,Percolators
Griddles
Steam Tables
Gravity Furnaces _
`Suspended'Unit 1. II
"Floor. Furnace
Miscellaneous
(NAME TYPE) I I'
Appliance Fees / —�—
Inspected—and Approved .................. ......... ._.......... ...._......_....
DATE. INSPECTOR