322 LOT NO. .
NO. STREET
r�•r APPLICATION FOR APPLIANCE PERMIT
1 CITY OF CUPERTINO
n
O Date 1 96..... Permit No. Z
'DEC 13 1% Vj Fees
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A�.Plication is(hereby made to the City of Cupertino for a permit to install
gasILP
bice�5rlis���lEtf� side hereof, and agrees to install said
appliances in accordance with t e provisions of the Plumbing rode of the City
of Cupertino, and al her laws applicable thereto.
Use of r ises
0-(Z
1n Owner Lj L S uo i-\ S 'V— Address io—
t`(/�, Address
`~, y CO ACTOR AGENT
(,WePhonef"/y-373$' Approve
PLUMBING INSPE
Remarks (Check ✓)
Type of Appliance Units Fees I New I Replace Relocate
Gas Ranges I II I I
Wall Heaters I / NIU11 I 1-
Gas Plates I II I I
Circulating Heaters
Blower Furnaces 1 I
Gas Fired Boilers
Warming Ovens I 11
Percolators
Griddles I I 11
Steam Tables 1
Gravity Furnaces '
Suspended Unir _
Floor Furnace 1 _
Miscellaneous
(NAME TYPE) I
I I II I
I I II I
I I II I
I I 11 _I 1
Appliance Fees T I 1 I
Inspected and Approved 0 3.�1.'.... .. ......................._..............
ATF INSPECTOR