1125 (2) It.• �\)(J��!�(�( i
NO. SMET
C-"l
APPLICATION ' FOR APPLIANCE PERMIT
CITY OF CUPERTINO
j
Date �/ �} 196..... Permit No.
��� I ��� �I lOti R Niel' Fee S
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
y of Cupertino, and all other laws applicable thereto.
2
Use of Premises
ryu
17i Owner _ Address
By r(/ Address
CONTEAC � AGENT '
Phone G—/ASO Approve
PLUMBING INSPRCThj
�S V
Remarks (Check ✓)
Type of Appliance Units Fees I New I Replace Relocate
Gas Ranges I
\Y/all Heaters I
Gis Plates I I II I I
Circulating Heaters I II I
Blower Furnaces
Gas Fired Boilers I I
Warming Ovens II
Percolators I Q
_Griddles I I
Steam Tables
Gravity Furnaces I II
Suspended Unit II _
_Floor Furnace
I II I
Miscellaneous
NAME TYPE)
I � Ip •fl 11 I
z: Q2S"SII
I I II I
I �
pp lance Fees
Inspected and Appro"ved .._ .-. .I.. . ..........................
DATE. INSPECTOR