1063 0 7'00 /ct.C.itl.-� LOT NO. �
APPLI ATION FOR GAS PERMIT
?JUL
2 6 1960 CITY'OF CUPERTINO //
36 195 6"o Permit No. !O 3
G11T Or
GURK1111V
Fee S
rn Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
Use of Premises_ 5 !til G /G (�) E S r D C AIC i
Owner O Address nn
gyS V CO Address
CO- CONTRACTOR, AGENT I
Phone`- O9-' I9 8 _ Approve
LUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance. I Units Fees II New 1 Replace � Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heater;
Blower Furnaces
Gas Fired Boilers
Warming Ovens
'Percolators
Griddles
Steam Tables it
Gravity Furnaces11 T I
'Suspended Unit —LH I
Floor Furnace _
Miscellaneous � � j�
NAME TYPE) I ^
.
pp lance
Inspected and Approved ..............:... ..................................... .........
DATE. INSPECTOR
.HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees '
_�_.;
Tested and Approved .. . . �...�.... .
ATE INSPECTOR