958 �'/�.�•� I 1`��VL�I.%� ��AZ/ LOT NO. 38
NO. STRBET Tract #3156
9 ,204
APPLIANCE PERMIT
CUPERTINO
-
AU!n
1
Date ..
9 ' fi2 ,
.F. 196.--_. Permit No.
' CITY:, OffPERTIIO Fees y'
:.
Application.is.hereby.made ro tke,�ity of Cupertino for permit to install
gas:appl�ances as listed on the;feyprx;siae hereof, and agreed to install said
appliances iri:accordance with thcpiovisions of the Plumbing bode of the City .
-of;Cupertino, and all other laws applicable thereto.
-
Pcettises" Res.
Camino;
OwneDel:: Address Boa Home's P 0 b
.,: r _
Cupertino'
Address
• � . CONTRACTOR,'AGENT �j ,•
:Phone. -ABs i App rov ' F.r
PLUMBING RISPHCfOR
Remarks (Check ✓)•+
Type of Appliance I Units Fees li Llew I•Replace I Relocate
Gas Ranges
Wall Heaters �T' •;II
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I II
Warming Ovens
Il^
Percolators '• �'
Griddles
Steam Tables
Gravity furnaces II
Jed Unit I I _ II' � '' • I —
'Floor Furnace
Miscellaneous I= • "� . '* 'k
(NAME TYPE) I'
TnI eUs,
�11.'fi1.9�i8�--�.�--i Z•
pp +ance •ees
In'speded and Approved . .n�l. ..o...t. i........
DATF INSPPCTOa
• e {