16466I/
NO. STaBBT (%
;AP_P,L'ICATION�, ,OR
LOT NO. /
APPLIANCE PERMIT
CITY OF CUPERTINO
-`' FF 2 jR 164 `V;
ate FEB 18 , 196..... Permit No. _
Y OF CUPER` Fees
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 c',ode of the City
of Cupertino, and all other laws applicable thereto.
Use of
RESIDENCE
960 CAMDEN AVE.
Owner INLAND EMPIRE DEV. CAMPBELL.
By MERCURY SHEET METAL
CONTBACTOa, AGa
Phone 739.42 3
kgs
Address 81 AVE., MT. VIEW
Approve
PLUMBING INSPBCTO
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace Relocate
Gas Ranges I I
Wall Heaters I
Gas Plates
Circulating Heaters
Blower Furnaces
.
Gas Fired Boilers
I
Warming Ovens
Percolators
I
II
_Griddles
Steam Tables
.I
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
I
'
I o I
so II
I
/
o
�
Appliance Fees
I/
Inspected and Approved
...................
INSPECTOR