677 A FOR APPLIANCE PERMIT
OF CUPERTINO
IffjAN 7 4 1 196..... Permit No.
S�'d L7s'-Ikt�1n�N�Y Fee S
CITAVppI tion o 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
1 of Cupertino, and all other laws applicable thereto.
Use o r mises
Lioz2
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Owner ' Address
By _ Address
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Phone Approv,
PLUMBING INS R
Remarks (Check ✓)
Type of Appliance Units Fees II New I Replace I Relocate
Gas Ranges
Wall Heaters I uo
Gas Plates
Circulating Heaters
Blower Furnaces �� J
'Gas Fired Boilers �� a
Warming Ovens �� s
Percolators
Griddles
Stam Tables
Gravity Furnaces
Suspended Unit II _
Floor Furnace
Miscellaneous
(NAME TYPE)
Appliance Fees
Inspected and Appro" A910 .. .._ . ..........
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DAT. INSPECTOR