1691r /
Ave.
LOT NO. 39
Tract #3442
1"V50W APPLIANCE PERMIT
C AF CUPERTINO
DateCi-0Y2 4CUPERTf-,b 96..... Permit No. /
Fee $--le
co Application is hereby made to the City of Cupertino for a permit to install
N
o gas appliances as listed on the reverse side hereof, and agrees to install said
'i appliances in accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
e
Use of Premises Re c
_u
D�w r 19r waWot _ Addre;408 N. Winchester
atl GaflB deer Irr�txr flt San Jose
779 N C014Y Rnnd Address
San Wdos, C TMON" CTOR AGENT PP
one A roved _
PLUMBING INSPECT
Remarks (Check J)
Type of Appliance Units Fees New I Replace Relocate
Gas Ranges I
\Y/all Heaters I l
Gas Plates II
Circulating Heaters
^Blower Furnaces 1 1 1 1.OQ X I I
Gas Fired Boilers I 1 11 1 1
Warming Ovens I 1 11 1 1
Percolators l II
Griddles II
Steam Tables l I
G;avity Furnaces I 11 I
Suspended Unit
Floor Furnace
IIRow
Miscellaneous 1 1
NAME TYPE) ( l
—_FAA I I n rel I
3 Ton Air CnInel I orl I
C�rfr b I —
pp lance Fees
Inspected and Approved .... .... �/�'......_...........--.....
I,1 INSPECTOR