1360 20 30 LOT NO. 23
NO. STRENT
J AQPLI ATl pN FOR APPLIANCE PERMIT
Vat
CITY OF CUPERTINO
� ``U
' AUGi 1963 '' �
Date AU 1 3 1983 196..... Permit No.
CITY OF CUPERTINO Feer
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 slid
appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and all other laws applicable thereto.
C
8 Use of Premises
2
OwnerA1.
v • Address
By Address
HEATING & SHEEfOMWVb AGENT Approved
18B 6.$bWR4�� AM-G ,
PLUMBING INSPECTOR-
Remarks (Check J)
Type of Appliance Units Fees' I New I Replace Relocate
Gas Ranges I
\mall Heaters I
Gas Plates II
Circulating Heaters I
Blower Furnaces / /,S-0 II I
Gas Fired Boilers
Warming Ovens
Percolators it
Griddles
Steam Tables
Gravity Furnaces I II
Suspended Unit
Floor Furnace
I I II I
'Miscellaneous o
NAME TYPE)
I z.zs II '
Z.oa II
I I II I
Appliance Fees (�S �—
Inspected and Approved ..............:
DATE. INSPECTOR