1458 (2) LOT NO. �
NO. STRHH
APPLICATION FOR APPLIANCE PERMIT
® "CA OF CUPERTINO
Date S 1 % 1QR2 3 / S�
X196..... Permit No.�_
PITY (1F rum F" = 7
Application is heieby madelto 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
u
r7 Owne L�'�Address
By Address
CONTRACTOR, AGENT
T Phone �/�✓-- ;07_ i - Approved 4
I PLUMBING INSPHC7CTit
Remarks (Check J)_
Type of Appliance I Units Fees I New j Replace I Relocate
Gas Ranges I II I
Wall Heaters j j jj j j
Gas Plates'_ j j jj j j
Circulating Heaters
Blower Furnaces I I a-olI I I
Gas Fired.Boilers j
Warming Ovens
Percolators I j
Griddles
Steam Tables j
Gravity Furnaces
Suspended.Unit I I II
Floor furnace;
'I i ' I
Misce nexus
NAME PFJ
• • I I -II I
Appliance. Fees �]--
Inspected and Approved .1.1. .Z ,. 3::.. ..........----- ----------
...---
nAT INSPECTOR
1