952V
APPLIANCE PERMIT
OF CUPERTINO
SE�t 1962' L�S
Due f,19G..... Permit No.
CITY OF CUPERTINO Feer
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 rode of the City
of Cupertino, and all other laws applicable thereto.
Use of
m
Ownel
,0741 CONTRACTOR, AGENT
R,,F 9 X90
Address 7S o�+,e
Address U 4/G
Approved
PLUMBING INSPacT
Type of Appliance Units Fees I
Remarks (Check ✓)
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
Mlscellaneous
,I
NAME TYPE)
Appliance
Inspected and Approved ....... ..._...... '.
DATE INSPECTOR