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No OR APPLIANCE PERMIT
Yo' OF CUPERTINO
Oa Date 196 Permit No. 5
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CITY OF CU ERTINO Fee $ 0U0
' 0 Application is hereby made to the City of Cupertino for a permit to
o a install gas anpliances as listed on the reverse side hereof, and agrees to
<N install said appliances in accordance with the provisions of the Plumbing
W = Code of the City of Cupertino, and all other laws applicable thereto.
W Use of Premises4/
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Owne�YO'tLL 9'�o.��A-�.J AddresS�
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2'0 CONTRACTOR,AGE
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011 State License a� Approved
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A U PLUMBING INSPE OR
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Remarks (Che ✓;
Type of Appliance Units Fees II New I Replace I Relocate
Gas Ranges j
Wall Heaters I I II I
Gas Plates II
Girculating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens II
Percolators _
Griddles
Steam Tables II I i
Gravity Furnaces Ih I
Suspended Unit j
2loor Furnace
i I II
Miscellaneous I it I
(NAME TYPE I I II I ._
1 42 II I
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c� ao 11 I
I I
pp lance ees DD
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Irispeaed and Approved ......... •......•.
DATE. INSPECTOR
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