656 r—rs rn:.Frive LOT No. 73
�P�P ;JAYT�.�l AOR APPLIANCE PERMIT
UU c'rcr OF CUPERTINO
Date CIT42eIV-0 jQER��"W096----- Permit No.
Fee S 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 residence
Owner Commonwealth Bldrs _ AddressCampb�l
T AAETAL.— AddressWH
kphoGilmaif" 7
no' ?FErO Approved `
- Campbell, California , ,;r ewa euv� wsc� oa
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges I
Gas Plates
Circulating Heaters ��
Blower Furnaces X
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
j Steam Tables
F Gravity Furnaces
f Suspended Unite—�—I�
Floor Furnace
Miscellaneous
(NAME TYPE) I �I
i
pp tante Fees —
Inspected and Approved
ATP INS PECTO0.
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