456 LOT No. � 1
P
1VIAIt1�U j95 N R APPLIANCE PERMIT•
ttt;;����►,lri p IIII�(� OF CUPERTINO
Dat G9G..Z Permit No. L� _
Fee $
Application is hereby made to the City of Cupertino for a permit to install
III gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing r:Gde of the City
of Cupertino, and all other laws applicable thereto.
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.� Use of Premises �--'—«
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rn Owner _ Address
By Address _
' 'sellHEA71NAL Ct
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A rove
ELL, F. PLUMBING INSPaC7Oa
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace Relocate
Gas Ranges
\Y/alf Heaters
Gas Plates
Circulating Heaters
Blower furnaces SD 11 1
Fired Boilers
,�Warming Ovens � � ��
Percolators
Griddles I ��
Steam Tables �� !
Gravity Purnwees
uspe
o
or ed Unit II
Floor
FlFurnace
j Miscellaneous it
NAME TYPE) I i II
III -
I
pp lance ees
Inspected and Approved//l%�. .. ... ... .............................
BATE INSPECTOR
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