1348 (2) pi�G I /�/An A •'• pw.l LOT NO.
f NO. STREET
a ,,r,,,, I ►T ON FOR APPLIANCE PERMIT
CITY OF QUPERTINO
'" ' AUG 7 1 03
Date � � py 196.� Permit No. /3
l~llFee E 6• �e
Application is hereby made to 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.
u
i
Use of Premises e
u ylp0 �G
in Owner Address-1,°_..�._ /�
By2 Address — r
NTRACTOR; AGENT
Phone 3 - y.�-�3 Approve
PLUMBING WSPICTOR j
✓h y I
Remarks (Che¢ke"✓1
Type of Appliance I Units Fees New I Replace IReloc�te
Gas Ranges Iu.)
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens _a I
Percolators I �_ I' I`' <
Griddles I °� ,�".—
Steam Tables I ;4
Gravity Furnaces
rS
uspended Unit— II
Floor Furnace
I I
Miscellaneous I g
NAME TYPE) I I 71!4
I
'CO�e pp�ianm Fees I I (�.
Via.
Inspected and Appro'ved '.O' L�* � � �Jli`at;��"""""
DATA INSPycTOR-
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