1214 03/ / [:/� 0/ LOT NO. �9 .
NO. 'STREET
�1
!APPLICATION FOR APPLIANCE PERMIT
1 r CI+Y OF CUPERTINO
chAY s4 i5a3 l
Dates 191-3_ Permit No. /oC
n� Fee E_ dda
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 code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises_ Q
Owner
Address
B17Jf. ., o �/Yz� Address
Z
l/
CONTRACTOR, AGENT
Phone =y��_3 Approve
UMBINC INSPECTOR
Remarks (Check 0
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges I II I I
Wall Heaters I II I
Gas Plates I I II I
Circulating Heaters I II I I
Blower Furnaces 1011 I I
Gas Fired Boi!ers I I II 1 I
Warming Ovens I II I
Percolators
Griddles I 1 II I
Steam Tables II I 1
Gravity Furnaces
Suspended Unit
Floor Furnace 1 I 11 1
I II I
Miscellaneous ti 1
NAME TYPE) I I I
I DId•3211 I
I I II I
I o2 I �voll I —
I I .odl j j Appliance Fees
Inspected and Approved . . .: '� .... ....... .._...... ..............
DATE. INSPECTOR