1764 (2) NO.
NO. s
„ a OR APPLIANCE PERMIT
W D MAY 201964
OF CUPERTINO
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3 'a Date— 196 Permit No.
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W W CITY 0 , C PERTNO /-
' 0 App kation is hereby made to the City of Cupertino for a permit to
o a install gas appliances as listed on the reverse side hereof, and agrees to
iN install said appliances in accordance with the provisions of the Plumbing
W = Code of the Cite of Cupertino, and all other laws applicable thereto.
aUse of Premises
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3'O CONTMCTO ,AGENT
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_U PLUMBING INSPECT
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Remarks (Check J;
Type of Appliance Units Fees II New Replace 1 Relocate
Gas Ranges 1 11 —
Wall Heaters
Gas laces 1{I
Circulating Hinters I II
Blower Furnaces
Gas Fired boilers 1 { II I
Watrning Ovens
Percolators 1 1
SQ —�—
res
teeamam Tables { 1 II I I
Gravity Furnaces
Su
spended Unitil
Floor Furnace { I1
Miscellaneous
NAME TYPE 1 I
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Inspected and Approved✓r_�� . .... .. . ...............................
DATE. INSPECTOR
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