1102 NO. , S7aBBT .. Tract !x3246
rAPPLICATION F.OR, APPLIANCE 'PERMIT
(AWjOF CUPERTINO
=1 A l l .?393
Date — 196----_ `Permit No.
CIT
,* �rU. �tl
Y Y V• �.��� i Fee S
Application-is`hereby made to the City of Cupertino for a permit to nstall
gas appliances as lisiWon the reverse side hereof, and agrees to install said ,
appliances in accordance with the provisions of theTluinbing rode of the Cita
of Cupertino, and�'alhother laws applicable theriio `;
Use of Premises RsE.l pis•"A,'i
in
Own erCaID1T10r:�?®j "++tf:1:88 `.', _ h. 4 .
ilddress
SAN CARLG)5 SHEET ME,TAL'yl/ORKS, ING , tr
77 =`:AddressC�
� uY
SAtlb L C�iLl��f a, AGENT Arove
-R' _ PP PLUMBING INSP
Remarks (Chert ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges y
Wall Heaters •'�_—
Gas Plates
Circulating Heaters �� . �• ..`
Blower Furnaces
Gas Hired Boilers ,� " • �� 'a;�;
Warming Ovens
.,.�.2,,;�y+r,:•;
Percolators -.F- •'¢ "+' 4d
Steam Tables �•' • . ���—T
Gra••uty Furnaces ��'; `•trw r�' •'
'Suspended Unit ,. #
Floor Furnace
,Miscellaneous
(NAME TYPE)
FOR12
Gas out,
_.l
pp lance FeesQ �� >w'►
Inspected and Approved .v.il DATE ... s* "M.........
DATF, INSPECTOR
di