1095APPLICATIOJ"F
WAN 14 196p
Date�f�ttT n
UREWTI
Application is hereby made to t
gas appliances as listed on the revers
3 appliances in accordance with the p
of Cupertino, and all other laws app
Use of Premises' ftt •
u
4.:e n- _lLarrnw�''�r�CT*A1�Wf)FiFD, c{l��Q'iy
779 LD COUNTY ROAD
SAN �ARLO , _ o _ _nc
LOT No, 5 -
Tract #3150
OR APPLIANCE PERMIT
TLOF CUPERTINO
NU.— Permit No. ' ��
00
Fee S
he City of Cupertino for a permit to install
e side hereof, and agrees to install said
rovisions of the Plumbing rode of the City
licable thereto.
Addressr r $Address STC
Approved
PLUMBING INs" a
Type of Appliance
I Units jees II
Remarks (,Check J)
New I Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates I II
I I
Ciiculating Heaters 1 I II
I I
Blower Furnaces 11 1 X1450
X I 1
Gas Fired Boilers 1 II
I I
Warming Ovens
Percolators
Fniddles I
I 1
Steam Tables
Gravity Furnaces
Suspended Unit I
Floor Furnace
I
Miscellaneous I
NAME TYPE) I
I I
Fee I 12 0011_
12 D3t-
II I
Gag Out I _Kell
_
I I
II I
pp lance Fees 1 17.0011
I
Inspected and Approved::._ oA'rF3 . ......... ......:---- ..-------
i
'INSPECTOR
To
You are hereby ai
Own6r or Tenant ...
At
No. of Meters
GAS5ICE
f ERVICE N it
BUkLDJNG INSPECTOR'S ICE
CITY OF CUPERTNO
No. of Add. Meters
110 7/61-500
io, cqgnect the
OFFICE
copy
......... 1196.S.
New Service -<�
- --- ---- --
- --
------- Reconnect ---------------------- -------
Move Service ------ -----------------
Move Meter -----------------------
--
-------- ----
-A
PLUMBING INSPECTOR
-1)