2674 //O(� �� / �fL�O►/VJ// be LOT NO. 21-
NO.
/Nn ® APPh CACITal
OR GAS PERMIT
w z �i ►JAN 14 1964CUPERTINO
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0
3 ¢' Date JAN 10 1964 196_ Permit No. C2t7
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CITY OF CUPERTMO Fee $
0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i a and/or appliances in accordance with the provisions of the Plumbing Code of the City
a of Cupertino, and all other laws applicable thereto.
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a Use of Premises
00
3 Owner Address
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By (-/ZO(( CF,� �O Address /7%✓ �EGU
CXJNIRACL OR,AGENT
3 ab V� ✓6
— 0 Phone f
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i0 n /1'6/ I Approved
o State License
0 P S E R
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Peccolators
Griddles
Steam Tables
Gravity Furnaces .�
Suspended Unit'
'Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPIN
Number of Outlets Si of ' ain
Gas Piping Fees If e
Tested and Approved ...... ._. . _. .... ......._............._._...............
DA E INSPECTOR