1344 __. LOT NO.
NO. STREET
APPLICATION FOR APPLIANCE PERMIT
CITY OF CUPERTINO C�//
DateIfll �. 14F; 196.... Permit No. / 3 V
Fee S p20.6.52
Application is hereby made to the City of Cupeitinb for a permit to install
gas appliances as listed on the reverse side hered and agrees to install said
appliances in accordance with the provisions of the Plumbing lode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises � 0
Owner / o+x.L C, r �/ ,c'�.�/' Address
By DIVISION Address
HEATING & SHE@b1�1'dFdd10AceNT
190 EPdt1XtlYOANS AVE., CAMPBELL, CALIF, Approved!/
PLUNBINj INSPECTOR
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ELECTRICR SEE NOTICE
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BUILDING I OF OFFICE
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You are her U.1 ed t ct el ctri, It servi or
Owner or Ter, rl. I
r� - - -- --- — – --- ---`---
f
--f---- ---- ... ..
At .................... ZI/—
...... ..�4)-------------- LLU. ..._..,.L.
----- -----
No. of Wires ........ ......... Size of Wires ------------Z�---- Size of Switch 1121. . .n
Motor Load .------------------------- Voltage ----- -------------------------- Phase --- ------------------
Heating Load ........................ K. W. --..... -- -------------- -- Voltage .................................
Light..........__.'--. 110...........1114�mZrvice Reconnect.._........__...
No. of Meters....................
No. of Add. Meters............
Heat.............. -A rft re- Move Service............
e
Power------ hmee ase..........v.— Move mAr..............
.................
--------------
................
104 1/63-500 ELECTRICAL INIPIC10ft