362 (2) 10.3&,91 � � > �� LOT NO. moi, r
.NO. STREET
� O TOR APPLIANCE PERMIT
N OF CUPERTINO
l pjJAN /
Date w 196---- Permit No._ b Z
l� CITY OF CUPERTINO Fee $ l
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 r'.ode of the City
of Cupertino, and all other laws applicabl thereto.
I
Use of Premi—
v
h Owner _ Address
& Address
Cr
NTMCTORr ENT ' ,(SCG[
Phone E 'c�! / Approve
PLUMBING INSPECTOR
Remarks (Check 0
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Floor Furnace U
Floor Furnace _
Miscellaneous � ii
(NAME TYPE)
I I�
pp lance Fees ��—
Inspected and Approved 2. %/, ...... ..........................
DATE. INSPECTOR
GAS SERVICE NOTICE OFFICE
COPY
�/ BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
..........................71."?l........................... 196......
To
You are hereby authorized to connect the GAS service for
Owner jor Tenant .....al
..
. ............................
At... . . . ............ ..................................................
New Service .................
No. of Meters ..../................. Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. Move Meter ..........................
...............�W�
LUMBING INSPECTOR
110 1/60-500