1303 &376
LIT NO r. 17-1
NO. �SIHHHr -
..,AMON FOR APPLIANCE PERMIT
Y C1TlfJ OF CUPERTINO
JUN 24�g§3
Daze ,�196_-J Permit No. C
�+ f1 Dp
C1 Y OF CU, Eliv.1." Fee S 7'5%
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 slid
appliances in accordance with the provisions of the Plumbing (•.ode of the City
of Cupertino, and all other laws applicable thereto.
u
e
' Use of Premises
n . OwnS� _ Address
By ewa'4"'�� 'Z(� c-
ACIOA, AGH
Phone Approved
e' - PLUMBING-WSpZerna ••:
T
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges I I I •,
Wall Heaters I I I
Gas Plates I II I s 'I
Circulating Heaters I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens I
Percolators I I ��—
Griddles
Steam Tables I II
Gravity Furnaces I ti
Suspended Unit I it
Floor Furnace
I II
Miscellaneous • I it
(NAME TYPO
I I II I
�v
pp lance 11;, 7.5
Inspected and Approved ... .... ..`: . ...�lrr.�ce"' :...:.•.....•........
nATP INSPP.CTOR�
I t