1629 LOT NO. 24,
APPLICATION FORCAPPLIANCE PERMIT
111) IF E B 2 8 196 c 4"Q' F CUPERTINO
Date �1"�1 n nl Inrnr�1196...._ Permit No.
VI t�ro_n
Fee Z 'd U
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
of Cupertino, and all other laws applicable thereto^
Use of Premises D
u
7 Owne _ Addres 0�2i
By Address J , M4
CONTRACTOR, AGENT
Phone U Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
Gas Ranges
• Wall Heaters
Gas Plates
-Circulating Heaters I�
'Blower Furnaces
Gas Fired Boilers
•Warming.ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace 17
Miscellaneous
NAME TYPE)
=pp
'nspected and Approved ...:. .: Z5� '_�_1 5.......................
DATE. INSPECTOR