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IpPIPLIC%1rTl'OI pROR APPLIANCE PERMIT
CITY OF CUPERTINO
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Daf 196../ Permit No.__Z_�
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Fee $4 g 47
tl Application is hereby made to the City of Cupertino for a permit to install
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gas appliances as listed on the reverse side hereof, and agrees to install slid
V appliances in accordance with the provisions of the Plumbing bode of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises
�n Owner Address _
By MERCURY SHEET METAL Alft Address 81 AL1 E AVE. MT. VI W
CONTRACTOR, AGENT
Phone 7 3 p— Approved
(1 /� PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New Replan I Relocate
Gas Ranges 1 11 1
Wall Heaters I 1 I 1
Gas Plates II I
Circulating Heaters I I 1
Blower Furnaces
Gas Fired Boilers 1 I 11 1
Warming Ovens 1
Percolators II_
Griddles
'Steam Tables I II
Gravity Furces
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S:spended Unit
Floor Furnace 1 1 11 1
Miscellaneous
(NAME TYPE)
ax,L, A4Z! ,& 1;23 1 ,5.7111 1
�. 1 1 2,s II I
I rdo II _
I` I II I
Appliance Fees
Inspected and Approved .. . n._� VI ...............................
IATF. INSPECTOR