302 (2) QLcor Nn 158
No. aer Idlewi,ld .Greens
AP, CAT bI OR APPLIANCE PERMIT
CITY OF CUPERTINO
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Date 11,/x/60 196 Permit No.�
'PERTiNO Fees .so
Application is hereby made to the City of Cupertino for a permit to install '
•gas appliances as17'.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 Res .
/�r�,Q Owner RnLgcoRLL QI• ,, _ . Address _
u ~ AddressUlu
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SAN CARL ._ _ '
Stet 779 OLD COLIN ff'ftWa, nceNr AppOLYrove
17
J "IeKL@5,, erWFGRNIA ING INSPa a
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• •• * Remarks (Check"✓)
T,yp.Lof Appliance f Units Fees II New I Replace I Relocate
Gas R`nge�� I II I
.Will Heaters
.Gas P.•l�ates-
Gifr_nlating�HeatersiT. . I
t3 "7t 1 I II X I I
Blovkr Furnaces
••=Gas' FidRBdi!ers
cW -• Ovef ss I I I
;Perrccdl"atoorrs
�GiR dle^s I I I I
' 'Sfeain7Tables I I I
Gravity;IFurnaces I_ .�_
SuspendeUnit I„'�,I.A II .. ✓
Floor Furnace III.i-
•
Miscellaneous
NAME TYPE I\(V
I I II I
I I II I
I I II I
I I 11 I I
pp Ia I Fees
Inspected and Approved -� .. -... x.......................
DATE INSPECTOR
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