1341 G16O LI/ _ LOTNO- o9
NO. ET
o PSE CC"ON FOR APPLIANCE PERMIT
'--�A CITY OF CUPERTINO
� j �I63F +n�a 196..... Permit No. J
Fee $ o'2O ol3
C TY OF CUPERTINO --
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 r'.ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises �4 �f�f
h Owner_ 9`✓`�.o— _ Address
Bye Address _
HEATING & SHR ENa
180�I�OptNvnnxe a ��: Approve
-91 PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
i Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators _
Griddles
Steam Tables
Gravity Furnares
Suspended•1Jnit II
Floor Furndce I�
I I II
Miscellaneous �I
(NAME TYPE
Iz5 I Zzs—II � I
I s Isoo ll -' I
I I II I
pp lance 1«s 2P F —
Inspected and Appro'ved�.?2 . .1. 7+.. ..........................
D F. INSPECTOR