441 (2) LOT NO.
NO, STREET O
3
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO // tt tt JJ 11
Date 196----- Permit No.4.
t. Fee $ S'D
Application is hereby made to the City of Cupertino for a permit to install
�y•� gas appliances as listed on the reverse side hereof, and agrees to install said "
" t appliances in accordance'with the provisions of the Plumbing bode of the City
of Cupertino, and er laws applicable thereto.
aUse of re ses
u r 1
n Owner Address
r
By Address
} CONTRA , ice
1 Phone Approved
{ Pw 6 G INSPECTOR
' Remarks (Check ✓)
Type of AppliaAce I Units Fees I New Replace Relocate
Gas Ranges •� ��
Gas Plates
ircvlating Heaters
_lower Furnaces
\ as Fired Boilers
arming Ovens
P- colators
riddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
Miscellaneous n
NAME TYPE)
Appliance Fees ( ��
Inspected and Approved��fa.`(�;...... . ..........................
MTF. INSPECTOR