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O LOT NO. p
N sneer
-APPLICATION fFOR APPLIANCE PERMIT
CITY OF CUPERTINO
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Date 1 1 f� %1 V ♦�n""^4 196..... Permit No.
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-R Fee $`� •a+
OF � ,�.
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 bode of the City
y of Cupertino, and all other laws applicable thereto.
0
Use of Premises RESIDENCE
u
— --Owner --- INaND-EMPIRE-DEV.- --
By MERCURY SHEET METAL
CONTRACTOR, A&KT
Phone 739.4223
960 CAMDEN AVE
_ Address CAMPHECC-Cal it _
Address 81 AJAE AVE., MT. VIEW
Approved C
PLUMSING INSPECT
Type of Appliance I Units Fees
Remarks (Check d)
I New Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates I
1I
Circulating Heaters I
II I I
Blower Furnaces /
Gas Fired Boilers I
II 1
Warming, Ovens I
II I 1
Percolators
Griddles
II
Steam Tables
Gravity Furnaces I
Suspended Unit
II
Floor Furnace
_
'Miscellaneous I
ii
NAME TYPE)
d4 0 /o a smell
1 2-1 Z'°
II I
I I
_
II I
Appliance
Inspected and Approved > .1y..... L . ..(<fav .............................1
DAT INSPECTOR