1176 1 � NQ Rolfe Road Lar No 18
2 L�a7
FLR APPLIANCE PERMIT
�mAR 2 8196�'20F CUPERTINO
Date March 20 1.96°x._ Permit NO—LI-7—Co
CITY 6 1t'tlt I
Fee$ 10,73 -
Application
10.73 -
Application is hereby made to the City of Cupertino for a permit to install
Le gas appliances as listed on the reverse aide 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 TrARIGN - now dwelling
8
OwnerLL%mT0ss Internrisea _ Address-JR 12 J.
gy ROYAL SHEET METAL, INC Ad 1 C md0 Ave. Camp
hon 878-778 ''AGaNT App
FLumB=INs
Remar Ch ✓)_
Type of Appliance Units Fees New Replace R to
Gas Ranges
_Wall Hasten I
Gas Plates II
irculating Heaters I II
Blower Furnaces 1 11.00II
Gas Fired Boilers
Warming Ovens
Percolators
Gri es T
Steam Tablas II J
Gravity Furnaces
rSuspBn ed Unit I
_Floor Furnace
Miscellaneous —�
(NAME TYPE)
Heat dubte @.26 9 2 i
Gas outlets 6 I I
Permit 2.O0
PP lance Fees 0.76
Inspected and AppmVed .................. ...............................................
DATA INSPECTOR
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