1648LOT NO. 9
T.-'P
O.=LICA
�AP�,���yIbON tOR APPLIANCE PERMIT
F�pp 11Q9q CFF' OF CUPERTINO
Due^(TyDIl lr� 196 ----- Permit No.
Fee S %'
Application is hereby made to the City of Cupertino for a per rt 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.
x
Use of Premises
RESIDENCE
960 CAMDEN AVE.
V) Owner INLAND EMPIRE DEV. _ Address rampgF, I _
By MERCURY SHEET METAL Address & AVE. MT. VIEW
CONTRACTOR, AGENr
Phone 739-4223 Approved
PLUMBING INSPeCTOt
Remarks (Check ✓)
Type of Appliance Units Fees New Replace I Relocate
Gas Ranges II
Wall Heaters
Gas Plates I II I I
Circulating Heaters
Blower Furnaces I o
Gas Fired Boilers
Warming Ovens II
I
Percolators I II
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
I I II
I
Miscellaneous
(NAME TYPE)
I I.?z.rtf
I
I I II
I
I t -II
I
I i II
r I
Appliance ,
Inspected and Approved
n:aaxyrna