287 (2) L A
_C�G S��A •`- LOT NO.
NO. ggFF STREET
NOV A 1PL AT1 - FOR APPLIANCE PERMIT
!+ 7V n ftOF
CUPERTINO
1_iDate � � 6..... Permit No.�.�
So
�/ (�F (+�� [p�'n'n
Fee
Lidri1is heiLtb'FIkddel ttl iQ City of Cupert no 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 ws applicable thereto.
u
G
Use of Prem' es
ui Owner �J _ Address
By 2 1 M - 1- Address G AN L
.� coNTancroa, AGE"Phone APProv
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates I I JI-41 _
Circulating Heaters 11
Blower Furnaces II L
Gas Fired Boilers II
Warming Ovens ��
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous ftl
(NAME. TYPE)
pp 11ance Tees
Inspected and Approved ..................;.........................................
......
DATP. INSPECTOR
GAS SERVIPE .NOTICE .0HICE
'd Co�y
BUILDING INSPECTOR'S OFFICE
�a 49�
CITY OF CU TINOrq
..................................................................... 196A...
TO
You are h -e orized to connect t G service for
Owner or Tenant
....................................
%k�
.................................
At.........t...t�3.. .............................
New Service .......Y.................
No. of Meters ....._L.._..........
Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. eter ..........................
............... . 1�
PLUMBING INSPECTOR
110
110 1/60.500