1891 __ af� LOT NO. /O
NO.
RJULGAS PERMIT
2 7 190 V CUPERTINO
Date '" '� 194� Permit No. O
RTINO
Fee $
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.
oma,
Use of Premises
v +
ro ._bq
Cn Owner Address
By Ala& Address @p
CONTRACTOR, AGENT - P
Phone "'3y7 i Approve
PLUMBING INSPE TOR
Remarks (Check d)
Type of Appliance .I Units Fees II New Replace Relocate
Gas,Ranges ��
Wall"Heaters
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens �� a
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous jj
NAME TYPE)
pp lance Fees --�
Inspected and Approved .._..........:...
DATF. 'CY INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size'of Main—�
Gu Piping Fees 1-0
—�-- d
Tested and Approved �. 4 .L...1... . ...... . .:........ ..................
D TE INSPECTOR