654 022 1 I Western Drive LOT NO. 21
NO. 5QEET
P-RIrfCZ►TIO-T:FOR APPLIANCE PERMIT
1CrrY OF CUPERTINO
EfDEC 12 1991
Date 12-5-61 196.-... Permit No._�
CITY CP CUPERTINO Fee 1.50
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.
use of Premises reBldeRCB
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ovv, -rCommonwealth Bldra__ _ Address_ _Q 611
Lo .SHEET INET®I._C Address
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Remarks (Check ✓)
Type Df Appliance (Units Fees II New Replace �'Relocate
Gas Raages
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces �� 8
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gra✓ity Furnaces
ti►Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
pp lance ees —��—
Inspected and Approved
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DA P. INSPECTOR
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