463 (2) 20970 , kpper Tree Lane LOT NO. `
rDn... ur
® APPLI p 0 .�QR APPLIANCE PERMIT
f APR 1 1��1 -ITY OF CUPER'TINO'
Datel ry /r18f ]i�CpTl�� `i
196 -_. ; '?Permit NO.
_Y M Vhf-�TCTf ..!.'�F t+R .,
`.'1` Fee a
�pAPPNi ahon-is hereby made.tg',4eoCity,of i uukiimo;fcr a permit to install
N gas appliances as listed on theareverses�de;hereof attd agrees to install said
—l' -.appliances:m accordance�.with,tlie prwoLisions of`the`..Plumbing code of the City
> n of Cupertino;grid allY`othei.laws`'applicable'thereto.',: ;.:.;'
:<8 -;ReB1denee
Use of Premises
." -.-J
.� GO Owner CommOn4V8a ith 7',It1 d-er-`A'adress ter
By p _ag bee!_'Xet A'ddiess a J )
CONTRACTOR, AGENT'
Phone Fr 8=0934 XpPrO
PLUMBING INSPE
r
a •
Remarks (Check Jr)
T%,pe of Appliance I Units Fees] New Replace Relocate'
Gas"Ranges
\(/all Heaters" '"� I�' •�
Gas Plates I I _ I I. " '
` ,Circulating Heaters.
Blower Furnaces 1 11 5011
Gas Fired Boilers •
, arming Ovens I :i'IeY:., .• . ,li'.::
Percolators- :'.SII "I' "I �'•'
Griddles
Steam Tables I sl✓-�'„i
Gravity Furnaces'
_ $uspended'"Un,t
Floor Furnace
Miscellaneous _ I ' I:_ ii •I,• . 1{
(NAME TYPE) ,. :I'' ?'I
I '. . I:
I I II I t
I I II I t
I 1 II IST
pp lance Fees ] 11.5011 I I
lrspected and Approved -----.........:...!...................:......................�....
DATE INSPECTOR
t '
J
IN