121 677 I /V Q. / u v�4 aw, LOT NO. d _
�. NO. STREET �
AP L-ICATI'ON EOR APPLIANCE PERMIT
iT OF CUPERTINO
196..... Permit No.
Fee S
4 -451atiCi_inas lieieliy'Made to the City of Cupertino for a permit to install
_ gas appliances as listed on the reverse sAe hereof• and agrees to install said
.A appliances in accordance with the provisift of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
40 Owner DIVISION
ON Address
By Address
Phone0 E. SUNNYOAKS AVE., CAMPBELL, CA, t y./�u
PLUMBING INSPECTOR
s
Remarks (Check ✓)
GaType of Appliance I Units Fees II New Replace I Relocate
s Ranges I I I I
Wall,lgeaters I I �� I
Gas Plates
I I II I
` Cirailating Heaters I I II_-T I
Blower Furnaces / !•SO1 `�
Gas Fired Boilers I I I I I
x"—Warming Ovens I I
Percolators
Griddles 11 I
Steam Tables I I
Gravity Furnaces I I I I I
Suspended Unit I I II
Floe Furnace I
Miscellaneous I ii
NAME TYPE)
I I II I
I I II I
I I II I —
I
pp lance Fees cc —
Inspected and Approved -71.:��.... -- ............
pATF 1NSPECTOa
GAS'-HkR ItE .NOTICEOrFICE
+corpy..
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
............ .. . 19.4�p
You are hereby authorized to connect the!GAS service for9 �
Owneror Tenant ............. .................... h.,..........-'-------..........................................
At 77-�
New Service ... ..........:......
No. of Meters ...._ ---------- Reconnect ..............................
Move Service ........................
No. of Add. Meters ...... ....... - Move Meter ..........................
E '
t � 'PLUMBING INSPECTOR
�,
110 6/59-5no ,