NO PERMIT NUMBER (4) LOTwo.
NO. STREET
„ a .APPLICATION FOR APPLIANCE PERMIT
z CITY OF CUPERTINO
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0 a Date 196—Z Permit No.
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= a Fee $
0 Application is hereby made to the City of Cupertino for a permit to
o a install gas appliances as listed on the reverse side hereof, and agrees to
In install said appliances in accordance with the provisions of the Plumbing
W Code of the City of Cupertino, and all other laws applicable thereto.
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LLUse of Premises .
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' w Owner /�"`J Address
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J z By e J/ Address 7S f
:'0 CONTRACTOR, AGENT
3P 7.jG - 9�.j3
— m Phone J
a o State License C Y3 Approved
—U PLUMBING INSPECTOR
Remarks (Check tr
Type of Appliance Units Fees'II New Replace { Relocate
Cam Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces G { {{ {
as Fired Boilers { — {
Warming Ovens
Percolators _
Griddles {
Steam Tables
Gravity Furnaces
Suspended Unities —f —
Floor Furnace
Miscellaneous { { {
i
PP lance —
.Inspected and Approved ............
DATP. [/ BCTOa
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