182 (2) .m.��;. vc7`�j`.�'in s+"..:%�1v��e .v1',._�•nT•`.zsM1-^�� v�w._n.�r� n.'Y .
/0
- Na STREET/,
APPLICATION FOR. APPLIANCE PERMIT/KV
talar CITY OF CUPERTINO
{may i
/� 196.0. Permit No. ZJ
D
Dat Y GF CUPERTINO Fee$/(5-0
Application is hereby made to the City of Cupertino for a permit to install j
C� 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.
u /
Use of Premises
Owner Addres- +�• #�
—3a CMOs
or
AddrA
San SAPPrJPh
L
PLUMBING INSPECTOR
-
Remarks (Check ✓)
;F, Typeof Appliance I Units Fees II New Replace I Relocate
i';,Gas Ranges
1v-,; �—eaters I 11 I
��is�glates I I I
'Circulating Heaters I I 11 I I
lSw;lt;�Fyurnaces I I I I
G ^'Fired Boilers I 1 II
Warming-OO vens I _' _
Percolator ,I
Griddles .'r 4,
Steam Tables' I I I
Gravity Furnaces
Suspended Unit _
Floor Furnace
I I II I
Miscellaneous
NAME TYPE)
I I II
I I II I mil '
I I II I
Appliance Fees
Inspected and Approved .. .. _............................
DA F, INSPPCTO0.
ll
.,
tKVltUt N 1p OFFICEA
G INSPECTOR"
CITY OF CUPERTI
------------------------- ...... ..................
5"
You are hereby aut !o 7id
h
Vt connect the GAS.service or
Owner or .Tenant ...............................
110, - --------- . ............
New Service ..... ........ ...... .
0. of Meter;........./
................ Reconnect ............
a. Move Service .................%:�,
......
f Add
Move Meterpf
-----------------77 ....
.. ............... .......................
......................
/,PLUMBING INSPECTOR
I 10