1326 (2) LOT NO. Z I
NO. STREET
y6Z3
[F .AP&%%Aj1ftP0R PAPPLIANCE PERMIT
qqCITY OF CUPERTINO
JU�JUL W1163'1-141
(o
Date , 196----- Permit No._.Z�__
CITY OF CUPERT-" ` Fee s
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.
H
e
Use of Premises—�A -•-pO•
rn Owner 4Z -e ,(Q Address -
By DI
ddress B9DI Address
(TRACTOR, AGENT
ppp,��� HE}ABH14fi & SHEET META( GQ Approve _ i.
180 E. SUNNYOAKS AVE.. CAMPBELL. MIF PLVAIEING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units FeesII New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters _
Blower Furnaces 1 ASo �� T
Gas Fired Boilers
Warming Ovens
Percolators _
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous.
NAME TYPE) II
e 400
pp lance ees a o
Inspected and Approved ... .......................
DATE. INSPECTOa
1