513 OCO'1—V14 PF'PP7T51PTi71P* TT,A LOT NO. .
NO. - STREET _ -
' • ,per. ..
APPLICATION FOR APPLIANCE PERMIT
CITY.OF CUPERTINO
Date — T 466..... Permit No. ^'
C. 1 JUI: 2" 1965 1111 Fee Z 1. 50
Application is hereby d .�° the��City of Cupertino for a permit to install
me P ,gas appliances a�rsted�o� he.i�eJeise�iiHe hereof, and agrees to install said
F-1 applia cnelin accordance with the provisions of the Plumbing rode of the City
of Cupertino, and all other laws applicable thereto.
C
Use of Premises reeldenre a
''n ' Owner _ Address —�� __
B J. �6 C '' �� Addres
130 I Gilman CONTRACTOR,'UG9NJgr App[O�
'w'!�'•• �•�� PLUMBING INSPHROR
i
Remarks (Check J)
.Type of Appliance I Units Fees II New. ��,Replace Relocate
Gas,Ranges
Wall Heaters
Gas Plates
Circulating Heaters I .1
Blower-Furnaces 1 1F H ��"•�
Gas Fired Boilers j
.Warming ovens
Percolators r?
gGriddles
Steam Tables
"GrayiEy�Eurnaces •�'�:=��'•;, �_ ��_ � -"! -a
Suspended Unit "' �' ' �•; II
Floor Furnace
Miscellaneous
NAME TYPE) I ��
�t
r
pp Iance Fees
Inspected and Approved �l�!/;._... ..... ...................:.::..
DATE INSPECTOR
1
GAS SERVICE.4 - TICE.. - °oPYE__
BUILDING INSPECT s 'oricr`." Iry
' CITY OF CUPSTO
..'"
You are hereby authorized to conned the GAS:serd¢e for'' 9K
Owner or Tenant .. ... .... .. ...
iAt. � ...` '.
New Service --- ..............
No. of Meters ---/.................. Reconnect
t; L Move Service ------------
No-of Add. Meters ........... -__----..
r .
, ^, ,.� c"I" Move Meter ..........................
irKr'.
.:� ... h
f
" LUMBING INSPECTOR ar
(y4�g 11011/60-500 T