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1458 LOT NO. � NO. STRHH APPLICATION FOR APPLIANCE PERMIT ® "CA OF CUPERTINO Date S 1 % 1QR2 3 / S� X196..... Permit No.�_ PITY (1F rum F" = 7 Application is heieby madelto 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 u r7 Owne L�'�Address By Address CONTRACTOR, AGENT T Phone �/�✓-- ;07_ i - Approved 4 I PLUMBING INSPHC7CTit Remarks (Check J)_ Type of Appliance I Units Fees I New j Replace I Relocate Gas Ranges I II I Wall Heaters j j jj j j Gas Plates'_ j j jj j j Circulating Heaters Blower Furnaces I I a-olI I I Gas Fired.Boilers j Warming Ovens Percolators I j Griddles Steam Tables j Gravity Furnaces Suspended.Unit I I II Floor furnace; 'I i ' I Misce nexus NAME PFJ • • I I -II I Appliance. Fees �]-- Inspected and Approved .1.1. .Z ,. 3::.. ..........----- ---------- ...--- nAT INSPECTOR 1