1742 y/Q55Le-z A�- Tract #3150
LOT No. 145..
NO. Sta88T Baywood Terr
21MAY
71TOR APPLI NCE PERMIT
YOF CUPERTINO
1?2 qq�yy�p�
Date 7�V/bt} 196..:.. Permit No.
00 CITY OF CUPERTNO Fees 7 �S
GoApplication 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 Premises Res.
Ward rump
Dev. nc.
P o sox 634
in Owne .r,.+a�µJn S Address
S�Car�osSi Iu= �a
0111 VVu.. i Address
OW WARM�alttaACTOR, AGENT
(� Sldtle
591 -2605 _ Approved
lU PLUMBING INSPECTO
Remarks (Check ✓)
Type of Appliance Units Fees New I Replace_I Relocate
Gas Ranges '
Wall Heaters
Gas Plates I I II I I
Circulating Heaters I I I 1
Blower Furnaces
Gas Fired Boilers I I II
Warming Ovens I II I
Percolators I
Griddles I I II
Steam Tables I
Gravity Furnaces I I II
Suspended Unit
Floor Furnace
I III 'ROW
Miscellaneous
NAME TYPE) I it
2 Vents I 12.OQI
,11 Outlets I2.7� I
Fee 1 *X-00 I _
I I II I
I I I
Appliance Fees /
Inspected and Approved7..f. .v�'-..I/ e.. .._.............................
DATE. INSPECTOR