984 .102� 12- LOT NO.
NO. RM
AP LICATION`FCT PPLIANCE PERMIT
1,OEQ j".�$�j,; CUPERTINOnce
J
Date >Y ., 3Cf{C116 . Permit No. Ito
:r. �• Fee S, 6
x Applicstloit,ishc&made[o the City of Cupertino for aRp!iWo install
r rf gas_ Tian stitl'o�n the ieq�tse_side hereof, and agrees to mstaD'said
p1janances In '00th the provisions of the Plumbing rode of the City
>' F ••+ f._FIpertin4 l other laws applicable t ereto.
Use of Premises Z
Wi Owner �r^^^ Address
By Address
HEATING & SHERIT MI?RC@�HA '
180 A rov
Pl3utit�ronRS AVF PoMPRq 1 f411[ f l PP PLUMBING INHPHCTO v
�+ Rema ks. (Che
Type of Appliance I Units Fees II New V Replace. Relocate
Gas Ranges ' n
\Wall Heaters •60
Gas Plates
Circulating Heaters Ji
Blower Furnaces
Gas Fired,Boilers
�I
Warming Ovens �—
Percolators "� —
Griddles
Steam Tables
GraviCy Furnaces
Suspended'+Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
!pp lance Pees -U d II —
Inspected and Approved/ f.0 ;.. .. ....... =r """""
D T.,!L !'a.. INSPECTOR