1776 LOT NO.
NO. e
fCA CON F A APPLIANCE PERMIT
f AY 211964 +OF CUPERTINO
,
Date '� II
,,,t9G..._. Permit No.
'd�t PICJ Fee s
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 inaccordancewith the provisions of the Plumbing rode of the City
of Cupertino, and all of er laws applicable thereto.
\ c
Use of Premises
(1�
Owner Address
By Ank Address
CONTTPA'CTOR, AGENT
Phone TApproved
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance I Units Fees I New Replace Relocate
t Gas Ranges
,_:Tall Heaters
Gas Plates
irculating Heaters
Glower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables I ��
Gravity Furnaces
75—udpiended Unit II _
Floor Furnace ��
Miscellaneous
(NAMETYPE)
r �02
Appliance
Inspected and Appro"ved//7/1 :za .�......
DATE INSPECTOR