1640 033 \ ._-+ Il(l Lor No.
%APPLICATION IFOR APPLIANCE PERMIT
F EIS IG �yCb�l CI1Y OF CUPERTINO
DateP' .' �Q6 - 196----- Permit No.
Fee S 0'i
Application is hereby made to the City of Cupertino for a permif to install
gas appliances as listed on the reverse side hereof, and agrees to install said
ti appliances in accordance with the Provisions of the Plumbing r'.ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises RESIDENCE
}; 960 CAMDEN AVE.
r7 Owner INLAND EMPIRE DEV. _ Address cAMPB ELL, CALIF, _
By MERCURY SHEET META Address 81 ALIC VE., MT. VIEW
CONiIlACTOR, AGE
Phone 739.4793 Approved
_ PLUMBING INSPECTOR
Remarks (Check J)
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 II
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
.Miscellaneous
NAME TYPG�
tee. zi ?T ,jr i
fru
Appliance Fees �J
Inspected and ApprovedC ',Li '�..._�.. . ..........._-..............._..
rTE INSPECTOR