843 1CCZc) _ n�` LOT NO Y] 01
,NO. STREET
OR APPLIANCE PERMIT
yr'1R&,1k
�,, OF CUPERTINO
UN 8 9962
Date 19G...._ Permit No. T91r"? _
CITY OF CUPERTINO Fee a�
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 rode of the City
of Cupertino, and her laws applicable t o.
0
8 Use of Premises Z
Owner _ Address
By Address
CONTRACTOR, AGENT
Phone Approved
PLUMBING INSPECTOR
i
Remarks (Check ✓)j
Type of Appliance Units Fees II New Replace j Relocate
Gas Ranges
Wall Heaters
Gas•Plates
Circulating Heaters jam_
Blower Furnaces
Gaz Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit �j
Floor Furnace
Miscellaneous
(NAME Type.) j j jj j
pp lance ees
Inspected and Approved ... _..... ..................
DATP. INSPaf.TOa
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