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® 'y �� (AOR APPLIANCE PERMIT
p t 9 3 19C2` 1 II TY OF. CUPERTINO
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I
Date /� 196.'�Z� Permit No-1-16-
CIA
o.
CI OF. UPERTIN Pee $ S�
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
(h appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other la applicable thereto. .
u
Use of Premi
�� ✓1 SO "
Own �✓�� _ Address
j By ` Address / 3
CON ACTOR, AGENT Q
Phone 6— 'L Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance—1 Units Fees II New I Replace I Relocate
Gas Ranges 11 1
Wall Heaters I I 1
Gas Plates I 1 II 1 1
Circulating Heaters I 1
Blower Furnaces
Gas Fired Boilers
If 1 II
Warming Ovens II I
Percolators
Griddles 1 II I
Steam Tables I I 1
Gravity Furnaces I Il_ I 1
Suspended Unit 1 I II I �—
Floor Furnace_, _.
I I
Miscellaneous ii I
ME TYPE)
I I D II I
I Imo,Bell I
II I ,00lll 1
pp lance Fees
Inspected and and Approved
..
.JJ..... ....... ........................
DATE INSPECTOR