1685 L10684 Deep CliffeDrive LOT No. 111
NO. STREET
Pip FOR APPLIANCE PERMIT
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(AF
OFCUPERTINO
AR 2 0 9964 ' / G
Da , 196..... Permit No. 1 U
CITY OF CUPERTINO Fee $ 11 .00
O Application is hereby made to the City of Cupertino for a permit to install
O
M gas appliances as listed on the reverse side hereof, and agrees to install said
L--
t-- appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
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v SFDWL
Use of Premises
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Zn Owner JONES _ Address _
gy LOS GATOS PLBG. Address 1-L444 Farley Road
CONTRACTOR, AGENT
Phone EL 6-4141 Approved
jJ PLUMBING INSPEC E
1
Remarks (Check J)
Type of Appliance Units Fees New I Replace I Relocate
Gas Ranges I 1 1
Wall Heaters I I I
Gas Plates II I
Circulating Heaters I I I I
Blower Furnaces 1 1 1
Gas Fired Boilers
Warming Ovens II 1
Percolators
Griddles
Steam-Tables
Gravity Furnaces I __
Suspended Unit
FloorFurnace
iS
I I
Miscellaneous
(NAME TYPE)
Vv,I,R UU,le s I _
I I II I
_Permit Fee 1 12.001 I
I �1 .0QI\ I I
Appliance
Inspected and Appro'vcn /..MI ,
...,..' . . .�........
STP. �INSPEC R