1530 LOT NO.
NO. STREET
® Afi-i rL�IC T-:10 FOR APPLIANCE PERMIT <
ITY OF CUPERTINO
t.� ' OCT 22 196.1
�3d
Date 196..... Permit No.�_
CITY OF CUPER S'° Fee $ n
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 lode of the City
of Cupertino, and all other laws applicable thereto.
e
Use of Premises
r X Owner C. _ Address ��� 702 'Z'4 .
Y By Address�.S�i� �Zc-Crirwm.J
�ONTRACTOR�fG"}�T
X Phone Approved
PLUMBING INSPECTOR
-1 Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Haters
Blower Furnaces
Gas Fired Boilers 1140, 11
Warming Ovens I 'I`
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II _
.Floor Furnace -
Miscellaneous
NAME TYPE)
II I
pp ante Fees &yo 11
Inspected and Approved ..............: ..'.
.....................
DATE. INSPECTOR