988 (2) ell
03/3
LOT NO.
NO. T
iPPLICA'T10 FQR1 APPLIANCE PERMIT
i"
,..,,.CITY OF CUPERTINO
Date OCT_ 9 '196296..... Permit No. L1 a
Fee f.
Application is hereby made to the City of Cnperum, for t Hermit to install "
,gas appliances a listed un tl.e revels side ` eL! ar_daFi€es tc msial' -.id
m ` : { ordance with c2ie prohsicr,s of -It_ I;m�:a{> ':.:e of the ap
4 C
all a;her laws applicable th&o ?=`
YfS,_1Y C` `P 1I
Owner _ �a.wiL.�Gq. - •�` •" ,r .
tV
B DDN v..
Address
HAZING & SHE87k*2 af0;e}g4-: , r' •t;
. l80..k& NYOAKS AVE.-CAMPBELL;:CBLIF.>, - - `Approve -
- PiOMBING INSPBCIO
Remarks (Check ✓) I
ape of Appliance I Units Fees New Replace Relocate
Gas Ranges
—%VRF Heaters I P�
GaA- Plates
Cirmlatmg Heaters I I
w
Bloer rn
Fuaces �II_
Gas Fired Boilers � � �� � a. `
Warming Ovens
Percolators
�—
Steam Ta les
Gravity Furnaces
Suspended Unit I II
Floor Furnace I I�
Miscellaneous I� I Iii
(NAME. TYPG) I _I
I I I I
pp iance ees I6 o p
Inspected and Approved ? ' .. ' • . • .• .• .........
DATP INSPECTo�
�P