124 LOT NO
MEET
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N. FOR APPLIANCE PERMIT
CITY OF CUPERTINO
'APR 20 1960
Date — ---, 196- ._.._ Permit No. /'2
ITY OF CUPERTINO - Fee sa
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 th lumbing r',ode of the City
of Cupertino, and all other la a pEcable th
Use of Premises
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r7i OwnerAddress yAs
By TBAddress
CONACI'OAr AGENT
Phone Approv
PLUMBING IN3PECTOa ✓
Remarks 0aeak ✓el
Type of Appliance Units Fees II New Replace I Relocate
Gas Ranges
\Walt Heaters
Gas Plates �• _
Circulating Heaters 11
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles'77
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace _l�_
4"
Miscellaneous 11
(NAME TYPE) I II
r .
pp lance ees t
Inspected and Approved QC+1 ..::.y...::;...:
DATH INSPECTOR
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