952 /O LOT NO.
NO. STREET
T OR APPLIANCE PERMIT
t OF CUPERTINO
1 S 'I G 1962 . L S Z
Due 19G..... Permit No.
a CITY OF CUPERTINO FK :
p 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
�y appliances in accordance with the provisions of the Plumbing r ode of the City
of Cupertino, and all other laws applicable
applicable thereto.
Use of Premises " "
R�9 X90
AOwner _ Address 7SW A-6-4.e
P r Address
CONTRACTOR, AGENT
Phone Approved
PLUMBING INSPecT
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II _
Floor Furnace
Miscellaneous ,I
NAME TYPE)
Appliance
Inspected and Approved .......DATE... ...:
... ................INSPEC. . ..... .. . ..TOR R...............