641 (2) O 0t BOnny nY'1 TT(+ LOT NO. 58
NO.
AICATION' FO j APPLIANCE PERMIT r
D C v 1 CUPERTINO
Date 1'= --
— 196-... Permit No. l�
Feet 1-90
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 rode of the.City
of Cupertino, and all other laws applicable thereto.
u.
Use of Premises residence
(A Owner Commonwelath Bldrs_ _ AddressrJQohl
'Logy mw Agmmi c® / ) Address
9J '.flrveaw Q.co�Tancl`on,Lc:Ni��?
Approv
' �iq✓��ri �r.us os.�� PLUMBING INSPaCT
Y
t + Remarks (Check ✓)
Type of Appliance 'tI Units:Fees II New, Replace I Relocate
Gas Ranges I ,I II I
Heaters I.
Gas Plates I • T II I I
Circulat:Gg Heaters . II II I
Blower Furnaces _�. I'.+ II x I I
Gas Fired Boilers', I• I'' I I'
Warming Ovens 'I' ! I II I I•
Percolators 1I_
Griddles
Steam Tables
Gravity Furnaces I
Suspended Unit I _ II
Flag Furnace I I ''; I
`I I
Miscellaneous
(NAME TYPE)
I I II I
I I II I
Appliance Fees, I 4 I
Inspected and App oved����.. .... .... ...........................
DA P INSPECTOR
a 1
Ui
1
' GAS SERME 'NOTICEOFFICE
COPY '
-r._• BUILDING INSPECTOR'S OFFICE '
51w CITY OF CUPFRTIN
> --..... ......-
14,
_
To - _ ....
You are-hereby auth r ed fo connect the GAS service for
Owner or•1 C/ F:rrn
enant
At: p� d:.VT'.�kj??207ZCcJ .. j ti
. .:+ ---- --:. .... . ..............:xh ...
New Service .`. '...::...........
No. of Meters ......--------------- "Cl'. Reconnect _------------------.._.---
Move'Service
'No. of Add. Meters .............. ` Move Meter_:_..------------------
PL BING INSPECTOR`_ -r
1101/60-500