961 ��KwY LOT NO.
NO. TractQ
® R APPLIANCE PERMIT
r
1976262 OF CUPERTINO
Date 9/24/62 , 196..... Permit No. 96 _
CITY OF CEIPERTINO Fre, . �.s:
N
OD o Application is hereby made to the City of Cupertino for a permit to install
r-i gas appliances as listed on the reverse side hereof, and agrees to install slid
appliances in accordance with the provisions of the Plumbing rode of the City
a� of Cupertino; and all other laws applicable thereto.
C �eM 4'Y.,e
%,Use of Piemises Rest-
Her
Aser o D Homs _ Address_P 0 Box–W94634—
By
oa W9 lE634_By :Address Cupertino
CONTRACTOR, AGE" >
Phone 26 o Approved_
PiV ING INSPeCTOR
. to
Remarks (Check d)
Type of Appliance I Units Fees II New Replace Relocate
Gad Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators I I
Griddles
Steam Tables' I 11 I
ravity Fu
Grnaces
Suspended Unit
Floor Furnace I 'I
II I
Miscellaneous
NAME TYPE
1'17 R1'.LM
Oatletri h� � a
60 _ sr�l I
pp lance Fees I II
Inspected and Approved L .L�}J..... _ ....................................
D TF4 INSPECTOR
•OFFICE
GAS S eopy
SERVICE TICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
.................... ----- ............ 196..L—
To
You are hereby an -to connect the GAS,e pef
Owner or Te
At-----
-—----- --- ----
..... ..... .... -- - - ------ ..... -----------------------------------
7
New Service ..... ------- ------------
No. of Meters ---/----------.....! j".. Reconnect .....
'Move Service ----- ------------------
No. of Add. Meters .............. w Move Meter ..........................
----------- --PLU I
-----------------
NG INSPECTOR
ILC NG
110 7/61-500