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C FOR APPLIANCE PERMIT
fY OF CUPERTINO
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Date 9' 3a 196_A�?- Permit No. / 6(01
CITY OF CUPERTINO . Fees I I oo
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 all other laws applicable thereto.
R.
e -
Use of Premises Ae,
0 Owner4ZeZZ& 9� Address _p '
Address
CO TRACTOa, AGENT
Phone D ! Approve `
PLUM ING INSPE 0.
i
emarks (Cherx ✓
Type of Appliance I Units Feesil New I Replace I Relocate
Ga Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces ,OpI ✓
Gas Fired Boilers
Warming Ovens I I II
Percolators
Griddles I
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous �iI
(NAME TYPE)
I I,C.OOII I
�.00II
i
pP lance ees
Impected and Approved,3277;!3.-... . ..........................
DATE. INSPECTOR
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