979U
c
NO.
ffiATION A
OCT 9 19620 F C
Dated - n'pEUF .!Z_
LOT
PPLIANCE PERMIT
UPERTINO
Permit No. 97 -,9 -
Fee
79Fee S 3 �O
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 slid
appliances in accordance with the provisions of the Plumbing :ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises— /--<- / U/f 707-
Owner-
.,
wner
By�s r COLS i
CONTRACTOR, AGENT
Phone
i
d C
Address
Address c3 3 3 7S
Approved��G�
PLUMBING INSPECTOR
Type of Appliance
Units Fees II
Remarks (Check ✓)
New I Replace I Relocate
Gas Ranges
Wall Heaters II
Gas Plates
Circulating Heaters
Blower Furnaces
Gas F� iced Boilers I
_
Warming Ovens
Percolators
Griddles
_
Steam Tables
_
Gravity Furnaces
I�
Suspended Unit
Floor Furnace
isce laneous I
ii
(NAME TYPE) �.
I
II I
I I
II
I I
II I
I
II .1 I
Wpliance Fees
Inspected and Approved.......
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