592 (�Oga,tl I EPPEDTREE L--Ny, LOT NO. 1�
NO. ,�• STREET
ARPLtCAVIO F�R APPLIANCE PERMIT
[OF CUPERTINO
Date 7—1 R-R1 196..... Permit No. '5
CITY OF CUPERTINO Fee ate, oe
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
of Cupertino, and all other laws applicable thereto.
o ..
Use of Premises r i e 9 N 3A P C gr
:rNrr��`�.gn�?t:IEALTH BLDD�', n nr 4ELL2 Own -. AddressOAMP ye azy.
Dg G;l; coNtnticrort;!nce'Nrti/ Addr ss
!) Pt:one----` "'r_s _»:e Approved
'l t-' - - PLUMBING INSP�GT A
P.
Remarks (Check 4)
Type of Appliance -I Units Fees II New, Replace I Relocate
Gas Ra`--ges
Wall Heaters I ��
GasPlatys I. I II
Circtdaring Heaters I I II I 'rr' •�I
Blower Furnaces `' I
Gas Fired Boilers 'I II
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces." I„[ I
Suspended Uriit.".:::;; I ' I II�—r
Floor Furnace I� I
' Miscellaneous I I ii
NAME TYPE I I I I
• I I � I
Appliance Fees 6
Inspected and Approved ................................
DA E / INSPECTOR
1 1 bbb
�t w
!I ) GASB-.SEIWICE NOTICE -_ OFFICE
'1�/f/l . ' BUILDING- INSPECTOR'S OFFICE
;.CITY, 'OF CUPERTINO .
.......................... ....
You..ue,hereby uthorized to connect the GAS service for -
� ��
-.Owner or Tenant . ... .....................
nr.. ....9...:............. ...� .. .: ..�..
New Service ........... ..... ........
No. of Meters .../---------------- Reconnect ...............................
Move Service .........................
No. of Add. Meters .... '...:. .,. -Move meter;.;----...................
=••
PL BING INSP..� ECTOR
110 1/60-500 ,.y ,