514 (2) PEPPERTREE LANE- Lor NO. am .
NO.,�.° STREET .
j -,-APPLICATION . FOR- APPLIANCE PERMIT
d OF CUPERTINO
,
YDatf -+ ..... Permit No. S
Fee $ . 1 . .90
'Appticafn.ls 'eBpad�tyhe City of Cupertino for a permit to install
gas appliances as llistedfon the reverse side hereof, and agrees to install said
appllaneeg5m accordAce4ith the provisions of the Plumbing Code of the City
.. ..e..
:y, of Cupino laws applicable thereto. �
Use of Preinlsess PBE1d BnCA
1 MOND .3
ti :•Owner C T n'ALT'-T Bj,j)Rpgddress F h
ESPOG"5 02a '''^_74'x, C� -
g B'y - ^" - Address /
Qx' 130 J. UJOIntiYtCONTRACTOR,lAGENTy�
Phoger* n4�al9-i;Cis:if:, A Approve
i
PLUMBING INSPEGZO
Remarks (Check d)
Type of Appliance Units Fees II New, Replace Relocate
Gas Ranges
Wall Heatersh 1
Gas Plates ( . . .:C�.• '`' ='�„� ta�ri;.
CirculatmgHeaters-,11
Blower Furnaces
7Gas Fired Boilers
Warming Ovens , ;' '_”
Percolators
Griddles '
Steam-TablesI I
Gravity Furnaces ,
Suspended Unit " II
Floor Furnace I
IN
Miscellaneous 1 .11 it
(NAME TYPE) �I IpN1
it h_
pp lance Fees
Inspected and Approved�1 ���,-- ........ ...............
DATE INSPECTOR
)
i
9
OAS 'SERVICE NOTICEOFFICE
*7 COPY
:.;.
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO j
.._....., 196...... ,
To �^
You are hereby authorized to connect the GAS"service for -
.• . Owneror Tenant .. . .. .. .. . .. .. ....... . .v--- --..._... .........------_._..,-
At
- New�Servicerl� .`:::.
..,:
No. of Meters .... ...'.......... ..................
Move"Service ue
Belv ,.-.::�..:. :............
ic x a
c p
No. of Add. Meters . ......_... Mote Meter
w I t� r
PLUMBING;,INSPECTOR
a �116 1/60-500 i ,.. ,.x,
f