569 (2)91
LOT NO. YI
NO.
PPLIANCE PERMIT
CTI 8 CUPERTINO
Datezr •� dq_�__ Permit No. J b l
I t Vlrt Iffl 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 ":ode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
Owner /O _ Address"PLUMBING
_
� k Address
cTOR, AGENr
NG & SHEET METAL CO. Approve
'1 r 180 .� fi� �\ INSPB R
"19
—
Type of Appliance
Units Fees II
Remarks (Check ✓)
New, Replace Relocate
Gas Ranges
Wsll Heaters
Gas Plates
Circulating Heaters
Blower• Furnaces / ob ��
✓ v
gas�Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
II
Floor Furnace
Miscellaneous
NAME TYPE) I
II
pp Bance Fees
inspected and and Approved %�fS�:z -. -........... :.........
D TP // INSPECTOR
.'l
GAS SERJICE' NOTIC caP,,
j BUILDING INSPECTOR'S OFFICE;_: L. _
CITY OF CUP ----- --- ---- - '
To
�s
You are hereby authorized to connect the GAS service for
.. Owner or Tenant/-' `C(� �.c,•.:-t<.'-f1..--- -...:.
At ..... l l.. /<Q_.7----
/
New Service'..__`.........:.
No. of Meters.:...... '
....._... Reconnect ..............
No.
No. of Add. Meters ..............
uA 4
un a I
t[,osoo
Move Service ----------
Move Meter ..__....---
PLUMBING INSPECTOR ;