640 (2) Bonny ori ire LOT.NO. 57
NOVA STaBBT•Y`_
. APPLICATION FOR APPLIANCE PERMIT
�9Cn ,� �A C OF CUPERTINO
R_v 1,9 1
=Date I2-5-61 196.._-- Permit No. �=
CITY r-.�'VERTINO Fee a 1. 50
4.r
Application-is'hereby,made to the City of Cupertino for a permit to install
gas appliances-islisted on the reverse side hereof, and agrees to install said
,s•,;,",,.,.
applian"cgs.im 4ccordance with the provisions of the Plumbing rode of the City
of Cupertirio,"and all other laws applicable thereto.
'•'`O'erUse of Preini sa:�l .i-residence
iLIME Commonwealth Address _
%finer FOEEY 6tEe�,L C® ,_ Address
���'�'' yBX 4RIQi1 COIJ3RACTQW A^uaNT,�t I
Approve ti
`._ _ +•--., PLUMBING INSPECT
w �`.•, OR'i
'••�• � d n "' � G n ".n `j �' o W p• 27 � N' w o'o .ptz
."
ul
� O
------ -------Y - mss'. :
GAS' SERVICE NOT �r . OFFICE
BUILDING •YNSPIlC`EOR copy
S;_O• ICF.`
CITY' OP CUPERTINO .� .'^`%��t '
Q2 % ......_..... . 1 96
You are.herehy auhonzed',to connect the GAS service for
Owner or"Tenant;:.... .._ . .
.. . .. ._ .. ...--_ .. .__---- -- - ---'_---
At .�2Q %d.. ... ------- :----. :.. :::....
..-- --
+• K' W. vlcC - -.
No. of Meters'.. -------- ` Re onnect ....................-- .
. ; . ;
• . ;.�, Move Service
,
No. of Add. Meters'.............. �; More:Meter ....._.....T...:._.....• -'
t+� r?�'� � PLUMBING INSPECTOR
II4rao I/6o-500