1690 lel 5-1 Pharlap Ave. g
LOT NO.
AM SM B Tract #3442
FWMAR301-
PPLICATI4017CUPERTINO
R APPLIANCE PERMIT
6
Da�p��/M/�I IOCDT=� 196.._. Permit No. _
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NPee S_/_tel _
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0 Application is hereby made to the City of Cupertino for a permit to install
I...t 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.
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Use of Premises Res .
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H r J Qac Elliot Addressl4_0�N.. Winchezer
Sall GarfoSSlilsAt IVlelal rurms -
779AddressSan se
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San r�arlos, f�r 6o5 Approved
P one—
M PLUMBING INBPaGTOR
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates II
Circulating Heaters 1
Blower Furnaces 11 1 1.00 X I I
Gas Fired Boilers Il 1
Warming Ovens II 1
-Percolators
Griddles I
Steam Tables _
Gravity Furnaces
Suspended Unit II _
Floor Furnace 1 11 1
I 1 II
Miscellaneous
(NAME TYPE) • Il
—Fee 12.NI
Ton Air CSI 1 I 2.0d I
2 Vents 1 1 2.Odl I _
11 Outlets 2.71 I
I
Appliance Fees
Inspected and Approved . p.:.. .'... ........................................
DATE
DATE. INSPECTOR