586 (2) LOT NO.
NO. STZ
A f � p'�'�PLIANCE PERMIT
I OCT 1 g 1§6� ERTINo
Date L 196-- Y x Permit No.
CITY OF CUPERTINQr
Fee S__
Application is hereby maden the Gty`of Cupe.gino,for a permit to install
gas appliances as listed on tlie-reverse side-hereof and agrees to install said
appliances in:iccoid`ance`..wlth theprovlsi66srof'thetPlumbing Code of the City
Y
of Cupertino'andiall other laws applicable 7theiretdsV,�'i -Z
Use of Premises r
a
iy S
iOwne Address_WPLUMBING
'
y Agarsi
�K TING &` 97A�E�fS s
dJYFtihne'ctiN., e,, Approved
+•,t ' _ e i NSPECT
`• Remarks (Chedc. ✓) -+
Type of ApplianceI Units Fees II New Replace I. Relocate
GP•s Ranges I I I I I___
Wall Heaters I I. =1 '►�:"'
Gas Pla•.es
I I II I I '
Circulating Heaters
(iPl . er Furnaces I / /.S o,II ✓ '.I
Gas Fired Boilers I .I :I ',';`. . • "`•� I
Warming Ovens
Percolators I I
Griddles I II I I
Steam Tables I
Grav4y Furnaces I I". II I
Floor Furnace I �•�� I I
Miscellaneous
NAME TYPE I C. c . II ':r._.•:.r I'.a
' I• �'I �r II I
I I II I
I
pp lance ees I /.30 �-
Inspected and Approved /.. ..��G/!......_. _...........................
�DATe INSPECTOR
r�
I1 I