1480 7
No. SIRE
F/FsEP
PLICATION FOR APPLIANCE PERMIT
p12 9963 CITY OF CUPERTINO / �/
Date / — la — 196.. Permit No. /7/o U _
CITY OF CURER i Fee S 2
l� Application is hereby made to the City of Cupertino for a permit to install
Ngas 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
i Own Address _ /
By Address eJ
CONTRACTOR, ACE, c
ry / Phone — Approved L
Remarks (Check ✓)
Type of Appliance Units Fees New, Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers f ��
Warming Ovens
Percolators
Griddles !
Steam Tables
Gravity Furnaces
:Suspended Unit II
'Floor Furnace
"Misce nous u
(NAME TYPE)
Appliance Fees y� �—
Inspected and Approved :.-.j�c ...i"` ._.. ._. .._.. . .. . .. . -
DATE INSPHCTOR
4