1684 P�' g"
_ OT NO.
NO. STRHlT
D P 1 OR APPLIANCE PERMIT
OF CUPERTINO
Dae , MAR Y3186A
196..._. Permit No.
CITY OF CUPERTINO Fee _AI-a
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.
c
aUse of Premises
n .lO
h XSwn ddress _
y 4cr Address_ S tel
/ r Oe]TancTOa, AceNr .
n /Phone 2 Approve �.
l6 / PLUMBING INSPECTOE
Remarks (Chuck ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates II
Circulating Heaters
Blower Furnaces 62— II 1 1
Gas Fired Boilers 11 1
Warming Ovens
Percolators I�
Griddles II
Steam Tables 1 1 II 1
Gravity Furnaces
Suspended Unit II �—
Floor Furnace
Miscellaneous
NAME TYPE)
I I II I
pp lance Fe /
Inspected and Appro've� _ Q.c
C.�_........._...._.
..
D P. INSPECTOR