584 LOT NO.
APPLIANCE PERMIT
nCT. 18 1961 49 F CUPERTINO
-Date - � � Y 6 . Permit No.
CITY OF CUPER S&
�Id Fee $ 311
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
i.,ti_?appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises'—
u
d
Owner _ Address
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Add
ires f
pP
t
�iEATING & SFPrfi"tEfET�"E'C(7"r A `io
18 �S9Ht�X8AKS-AYf, 6/tMP®€I.I
P VMBING INSPH A
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°.. Remarks (Chedr J) -
Type of Appliance I Units Fees�;ll7N° ,;w Replace Relocate
Gas Rar_ges
wa-11 Heaters �� �_ '''•':'v.'
Ga Pl-jes
Circulating Heaters
Blower Furnaces - 1_
Gas Fired BoilersI.
Warming Ovens
Percolators
Griddles
Steam'Tables
Gravity Furnaces
Suspended T,47 —
Floor Furnace
Miscellaneous t
NAME TYPE) } ��
pp lance Fees��Ile
Inspected and Approved/. a??���.-.-
..............................
ILI :DATE INSPECTOR
s—
a�
GAS , SERVICE N TIE
OFFICE
I ���. f OPY
hP C�
BUILDING INSPFCTOR'S O FICE
CITY OF CUPERT-119 /
To.
Von'arc hereby authorized to connect the GAS service for -.
-} �! Owner or Terianf L//k'E'
�j%t•Y-1�
'At-.. ✓- ................
/ New Service,
ci
No. of Meters ......1.._------------• ` Reconnect ...............................
Move Service
No. of Add-.Meters .:.......
M
"
fa.�r • ove Meter' •-
) PLUMBING EVSPECTOR`
f l' 04t/f60.300 �' f" <.T� -f 7- 'S�-. .1. 4•-s.. '.. 1 >
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