844 NO. SUBET
6ON 61140%01t APPLIANCE PERMIT
OF CUPERTINO
JU P 1962
Elate 196. Permit No.
CITY OF CUPERTINO /
1c� Fee
v) 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 c'-ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
e c
Own • ddress
p; Aaar�s_K 74- ` Sf OAVLttap.
Pl:nne,D�—`0l3fit ApprOv
PLUMBING INSPECTOw
Remarks (Check J)
Type of Appliance I Units Fees II New Replace Relocate
Gas,Ranges 11
Cr/all'Hcaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Flre Boilers
Warming vens
Percolators _
s
ravihvfur2aes
;E%pepded Unl
Floor'Furoace I
�4
Miscellaneous � � ��
(NAME. TYPE) I II
pp lance ees
Inspected and Approved ...
DATE. INSPECT K