1792 S E -_
APPLICATION FOR APPLIANCE PERMIT
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,� c 1 AU 2 4 99614 OF CUPERTINO
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0 � D. � '� 196_ Permit No. /
W U V IIVU Fee $
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' o Application is hereby made to the City of Cupertino for a permit to
o i install gas appliances as listed on the reverse side hereof, and agrees to
i N install said appliances in accordance with the provisions of the Plumbing
i Code of the City c Cupertino, ;11 all other lis applicable t ereto.
nUse of Premises u - /�e{A,�i
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Owns' Address x'01;;e d', '
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= By Address
�'o CtfNTPLACTOR, AGENT
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Phone3�� —ZcJ7?i
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o i �ate License% 7 6 ApprovU PLUMBING�INSPECMR
Remarks (Check ✓;
Type of Appliance Units Fees I New' I Replace I Relocate
64TRa
Wsll Healers I I I i I
Gts Plates I II I
Ci;adating Heaters
:Blower Furnaces I I I
Pis Fired Boilers
Warming Ovens II I I
Percolators
Griddles
Steam Tables I I it I I
Gravity Furnaces
SI I I
uspended Unit I it
Floor Furnace I II
Misce112neous I I
NAME TYPE)
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/qtr-en P.F./Y�� N I
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Inspected and Approve .. . .. . . . ......
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