649 Western. Drive LOT No- g6
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�P 110 RAPPLIANCE PERMIT
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CITY CP V IPERTINC Pee 3 1.50
Application is hereby made to the City of Cupertino for a permit to install
gag appliances as listed on the reverse side hereof, and agrees to install siud
appliances in accordance with the provisions of the Plumbing r'.ode of the City
of Cupertino, and all other laws applicable thereto.
a Use of Premises reeidenoe
Owner Commonwealth Bldre, Addreamvbell
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Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Rekxate
Gas Ranges ��
Gi Ft es
Circulating Heaters
lower Furnaces
Gas Fired Boilers J
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces •. ��
'Suspended Unit
Floor Furnace
Miscel aneous
(NAME TYPE)
PP lance ees
Inspected and Approved ...... .... ...............................
DAT-P. INSPECTOR
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