655 f o'z3 f I Western Drive LOT No. 72
No., ., MEET
AP IC., TT OW FOR APPLIANCE PERMIT
CITY OF CUPERTINO
Ig a6l
Date i9G..... Permit No.
to CITY Of 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
H appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
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e
Use of Premises—re s.1dence
Y 4
�LOwaer rommonrean-T th M-L-S.. Addressm beLl-
S"E'prrdCln
T Address. _
r �, cTor�,"`�-;3 Approved-(
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SPECTO y I
Remarks (Check V),
Type of Appliance I Units Fees II New Replace i Relocate
Gas Ra,lges
Wall Heaters
Gas Plates —T
Circulating Heaters I I- II
Blower Furnaces R
Gas Fired Boilers,
Warming Ovens
Ikrcolijors
p�(3riddles � I I� � I
Steam--Tables
Gravity Furnaces
Suspended Unit
Floor•Furnace
r,
Miscellaneous I ii
(NAME TYPE) II
II I
I
pp lance ees
Inspected and Approved ........ . ............................
DATE. INSPECTOR
� / / 7
FL
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