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1150 NO. �STRagT _ LOT NO. � I OR ft PEICATOOl' FOR APO'LIAkdk PERMIT if FEB 2 81969`A&F CUPHRTIN' 0 Date ��2 tK �E69�6- 3 Permit No. ( � V E6 Fees 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 appliances in accordance with the provisions of the Plumbing rzde of the City of Cupertino, and all Other laws applicable thereto. u Use of Premises�� ti Own 6'W""` _ Address n By Address2 CONTRACTOR, AGENT Phone d 2 3 K 1 Approved • PLUMBING INSPE R Remarks (Check ✓) Type of Appliance Units Fees II New Replace Relocate Gas Ranges Wall Heaters Gas Plates Circulating Heaters Blower Furnaces 1.3 11 Gas Fired Boilers Warming Ovens Percolators Griddles Gravity Furnaces Suspended�Unit Floor Furnace M;pcellaneous (NAME TYPE) Til pp lance ees —� Inspected and Approved ............... ..'................................. .............. DATE INSPECTOR