1680 .LOT NO.
ND a
tr i 111,,T[O tFOR APPLIANCE PERMIT
61TP OF CUPERTINO //
196..... Permit No.A_
Fee S za6-
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 lode of the City
of Cupertino, and all
JaS other la
ws applicable thereto.
Use of Premises W
Own &
Address
By Address
C N CTO 'r AGENT /
pi ak
Phone Approved
3r PLUMBING tNsre a
Remarks (Check ✓)
Typeof Appliance Units Fees I New Replace Relocate
Gac'Ranges
\/all Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I I
Warming Ovens I I I
Percolators I �_
Griddles I it
Steam Tables II
Gravity Furnaces
Susperided Unit
Floor Furnace
I I II I
Miscellaneous
(NAME TYPE
Y a° II
I I II I
Appliance Fees Z
Inspected and Approved ._ ,
. ................ ...._ -----------..-.
AT � INSVE..CTOR '