516 IDEPPERTREt"LANE LOT NO.
NO. STREET _
�APP,L�A N QR APPLIANCE PERMIT
1 61 : OF CUPERTINO
l� 1JUL 2 _A IJ
Date7—TR—Fil 196.::t Permit No. :
CITY OF CUPERTINO Fee s IG�
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 rode of the City
y<; of Cupertino, and all other laws applicable thereto.
a, ,Use of Premises o t P o n na
0MMONWEL- � Address f!f BLDR p * ^
Ji�'Owner ;, AL,,,..
{g+ ,' -', �silk''.f,'s.sye Address-(L' - z'
`` t�tc-.f..T •_�3c' i a A66R .4iNr I';t
SPS c'gey' , N .PprOved "
-�• 7 PLUMBING INSPECTOR 4
.r Remarks (Clieck ✓'1'r
Tylt,`r(Appliance_,;IUnitsFeesll New_ I Replace;I,Relocate.,
Gas•'c',,ges +.
\t!!all Fiters _�
Gas Plates I 11 l I
Circulating Heaters I
Blower Furnaces 11 I< Ili X I :"�' ' -411"%'E
Gas Fired`Boilers I I I 't 'I'. �`,'a49
t
Warming Ovens I I •••r`d ' I "'i
Percolators I �I_ I -• �s'.:�` �
t ' Griddles I II ".:�I :,,;'.::
StewuJables I I
Gravity Furnaces. I I II_ I� ■. 4
Suspended Unit...,,. I •II ''+" ._
Floor Furnace I II
f(('NA!ME
ous
TYPE)
h^E i II
I I 11 h_
PP ranee Fees Inspected and and Approved/1.Z�jC.�.."" .J..�- --'
� n P tNSPECTup �"'•l,� J�'
PAS
P,
GAS' SERVICEICE OrFIC
.•� BUILDING INSPECTOS,OFFICF. ~
SCJ '" �;.....=.�.-s-,-•
CITY OF CUP6RTINO
p
r:
��! _.........:, .196_ ..
To
You"are:heieby authorized to connectsthe.GAS sen Ece for -
Owner or.Tenant .. . . - .. ..........................
At
•, sa .. -. y .�:�.t•,�; x ..+& rMNea Service ✓ .
/ 4
a No of Meters .. ! ... :. "Reconnect................................ ^r
•" v`,, Fg' Move Service
r
14 No�,of+Add Meters � . � Mose Meter
` / �r a' ..
,.Y
PLUMBING INSPECTOR'�
ri LZ Ri�r'°.i n."✓...-�r1�" i l 5` 'a:x tt h p.: