697 TO 75/ LOT NO.
O N ql�l
N Fkk3Ct3 TIR APPLIANCE PERMIT
eI JJJ�����' T���n F CUPERTINO / q
Date RUPFRTI `/G-� Permit No. 7
AV t t� Fee $ /•
Application is hereby made to the City of Cupertino for a permit to install
3j gas appliances as listed on the reverse side hereof, and agrees to install said
M appliances in accordance with the provisions of the Plumbing r7ode of the City
of Cupertino, and all other laws applicable thereto.
ac �
Use of Premises "•r�2 J
.- Owner /,P ` � _ Address/545 _ .4i.w_/-�!/,71i_L_.
n.. Al'
Address /f/•�d -A— .
Jt4,, , i ._�
COWMA¢roa, AGENT .�/,/J�--�—�f�
Pi:nre iC�G -f//Y Approve_�_"'�^r-_
"UAa1NG IN.PECivw
Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
as Ranges
\C/all Heaters
Gas Plates
Circulating Heaters
Blower Furnaces �� ✓
Gas.Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II _
Fleor Furnace
Miscellaneous
NAME TYPE)
Appliance lance Fees
I..Ispectea and Approved _ ...__...:... .................. ............................
i DATF INSPECTOR