439r
LOT NO. T
S ET � Uf, l
APPLICA ION FOR APPLIANCE PERMIT /
CITY OF CUPERTINO
' Date 196----- Permit No. T/ 3
G Fee$
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 said
appliances in accordance with the provisions of the Plumbing rode of the City
\g Of Cupertino, and all o er laws applicable thereto.
2 �
+ ` Use of r ices
u
05 Owner Address _
t
By Address e
CON CTS , AGEN
1 Phone Approved
PL ING INSTECTOR
�S_��
t
Remarks (Check ✓)_
,Type of Appliance '�Units Fees II New Replace Relocate
Gas;Ranges1 1 11
' si�%i ltljeaters
f Gnnd
+y',C•I acing Heaters �. • �. __ �� � � _
ower Furnaces
Fired Boilers �� '
vens
'
GL32 H es I 1 II �•
6WWm Tables
GraJity Furnaces -
Suspended Unit II _
Floor Furnace
Miscellaneous u
(NAME TYPE)
pp lanceeel i I I
Inspected and Approve . .................................
DATE INSPECTOR
+ 1