1230 A) I G� � LOT NO,
NO. STRMINI
ae-T�,
MON�F�OR APPLIANCE PERMIT
Cv OF CUPERTIN0
Date IN 153 196-.3. Permit No..
CITY OF CUPERTi11,I0 Feer Zj'
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 f:ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises _�Zdcoe
Owne Address
Bye-Z�C,u..� 9 Address
ONTRACTOR, AG
Phone_ `7T�9—ye2�2 Approved
�, / PLUMBING INSVR
Remarks (Check J)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges I 1
Wall Heaters I
Gas Plates I II I
Circulating Heaters 1 II I I
Blower Furnaces 1 X11 1
Gas Fired Boilers I -
Warming,,Ovens
Percolators
Griddles
Steam Tables
i, Gravity Furnaces
Suspendednit
!. .*Floor Furnace I 7
Miscellaneous
NAME TYPE)
I I I
I I II I
i I 0,9 11'ZoI
Io 11 1
Appliance Fees 1 �—
Inspected and Approved ..e`?:z.7d... ...............................
DAT P. INSPECTOR
'� 3