1103 (2) LOT NO -49 .7 .
N0, �11`EET Tract #3248
K �S
A?PPLICATION FOR APPLIANCE PERMIT
",rC53CiOF CUPERTINO
Date_t_1�4� ,.196..... Permit No. C)�
W11 1i, �� � II�a•
Fee$- Y—
Application is hereby made to the City of Cupertino for a permit to install -
Ngas appliances at listed on the reverse side hereof, and agrees to insfall said
appliances in accordance with the provisions of the Plumbing-e ode of the City
0 of Cupertino, and all other laws applicable thereto. Ifl1f,
Useof Premises R s b�1{'V
8
H
Owner C&irii D Hnmraa Address ' `t
DAN CARLOS arl4 TET71 �DNKS,M---, —
778yCl - � Addressc
lei:
SAN CARLOS, !fna, AGENT
Phone' - 0 Approved
_ I PLUMBING INSPE
Rearks (Check ✓)
Type of Appliance I Units Fees II_ m
New I Replace I Relocate
Gas Ranges II III
Wall Heaters I
Gas Plates ( I aw
Circulating Heaters -11
Blower Furnaces ] ] X
Gas Fired Boilers I
Warming Ovens
Percolators
Griddles I I l
Steamteam Table- I I + '
Gravity'' ;Wates
'`-T"Mpen cd'Unit
„ce-:, _
Miscellaneous
NAME TYPO I
Doll 1
11 out. 2. II I
Gas out. OII 1 _
I I II�•�
pp lance ^ees
.. •.
Inspected and Approved 'ff 3{.. .. ........4...s-..............
DATE INSk(fTOa ya
• 1