1023 (2) 2
LOT;NO. 7
NO. STBBBT t -
ZNtEN" F �R APPLIANCE PERMIT
I1"yOF CUPERTINO.OV '8 1961
7.
Date 196..... PetmiUNo:.
4 CITY Or CUPERTINO Fee $
,Application is hereby made tdthe City of Cupertino for a permit to install
gas appliancesias listed-on the reverse side hereof, and agrees to install said
>;appliances in ac2ordance'with the provisions of the Pli" bing rode of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises
"
_ fstt#J '�iQ t°om r' 44SAWCA MNEERWMLAddress
OD r '
_ -
COUNTY D f� S 34':
r" ROAAddress
"??SAN_CARLOS,,,ftArSdfila� nceNr� � ,-' �. .'
'".'•Phone " a r" ` t , " Approved
PLUMBING INSP 0
Remarks (Check d)
Type of Appliance I Units Fees I New, Replace 1 Relocate
Gas Ranges 1 II 1 I
Wall Heaters 1
Ga' Plates I I 1
Circulating Heaters
Blower Furnaces I. I -.5 oil 1 1
Gas Fired Boilers 1 1 I 1
Warming Ovens
Percolators I 1 it I
Griddles
Steam Tables I II 1 1
Gravity Furnaces I II 1
F ,Unit
Floor Furnaces` I II T
I 1
I tl I
Miscellaneous I 1 ,i 1
NAME TYPE) .i -''
Fee 1 12.0011 _
12 outlets 1 .0011 1
1 Gas Outlet 1 .5011 1
I I II I _ _
ppm ees //,
Inspected and Approved ` 7 _�.._.'. .
.............. .........................
DATE INSPEr.TOR
�t
OFFICE
'COPY
GAS-,
GAS, SERVICE W'dQ ICE
BUILDING INSPECTOR'S ,OFFICE
CITY KCUP,E�J,(TINO -
•..
,.r
To
You are hereby auth d to cougect the G er '
Owner or Tenant .._ - _-.- ,.._ y .--__
At ----- � 33.: �% .. ---
- -----------------------
_.
/ New Service _.6 ....._....::.-
No. of Meters ...../.------------- - Reoonnect ........._-:..............
_ Move'Service .....:...
. ; No. of Add. Meters ------- Move Meter ----- -------------_....
a
------- _.... .. . .._..._......:....._............. ......... .
•r. p.,..110-7 611500.,;.