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1. FOR APPLIANCE PERMIT
KCA79TCITY' OF CUPERTINO
APR L.
rz
Date 196.. Permit
I CIT
No.
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 code of the City
of Cupertino, and all other laws applicable thereto.
Use of
rn Owne O/-•e.���
By
CONTRAC NT
Phone
PLUMBING
Type of Appliance I Units Fees
Remarks (Check ✓)
New Replace I Relocate
Gas Ranges
Wall Heaters I O V I
I
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I I.
Warming Ovens
Percolators
Griddles
II
Steam Tables
Gravity Furnaces I
I I
Suspended Unit
_
Floor Furnace -
_
I/• ap
II
Miscellaneous
NAME TYPE)
I I
II I
�I I
II I
w la i�
Appliance ,Ud
Inspected and Approved ....._ ....... :....._..-_......................................
DATE. INSPECTOR