1775 �" I - • LOT NO.
NO. / �,
LICATIO'N-TIONPERMIT
Rc MAY-(( -62,W
AY�2Q 196,Cn �,ytF CUPERTINO
Date—S -I( —"te ,61996----- Permit No.�
CITY OF CUPERT "0'
Fee $
NJ 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
V1 appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and.all other laws applicable thereto.
Use of Premises
V) Ow Address _
By �hjAddress
CONT AC a, GENT
Phone S Approved '
lD - rtu>rerNc tNsrec�o
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
:Gas Ranges
Wall Heaters
Gas Plates
'Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators I�
Griddles:
Steam Tables
Gravity Furnaces
SuspendedUnit II _
Floor Furnace
Miscellaneous
NAME TYPE
i-vI�J II _ 1
pp lance Fees
1'nspected and Approved//O-a20p-�_........ ._.............................
DATE. INSPECTOR