1641 103 7 C - LOT NO.
APPLICATION FOR APPLIANCE PERMIT
f 4U c. v i�irrt CITY OF CUPERTINO
Date^ tYFOB UJAR-"'7196..._. Permit No.
1.�
Fee S
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.
Use of Premises RESIDENCE
P 960 CAMDEN AVE.
JS Owner INLAND EMPIRE DEV. _ Address CAMPBELL. CALIF
By MERCURY SHEET METAL . Address 1 AL V MT. VIEW
CONTRACTOR, ACE
Phone 739 4223
I. PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators' I�
Griddles
Steam Tables
Gravity Furnaces I ��
Suspended' Unit T
Floor Furnace
Miscellaneous n
TNAME TYPE
Appliance,Fees I
Inspected and Approve '�:>L�. '!....�jj............
DAT. 1 INSPECTOR
� 1.