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® APPL CgATION FOR GAS PERMIT
w z NOV 13 1963 CITY OF CUPERTINO
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3 a Uri l 196-3, Permit No.
W .. Fee $ �J O
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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(n and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other laws applicable thereto.
Use of Premises
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3 Owner A,/ , z) Address GlIPE.eii r/O
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� z By C>�/�i*JL�� Cam Address
O CO CTOR, AGENT
30 �2E�—Z/�20
— m Phone
/6G 9 J cQ
a o State License Approved 1,
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p� PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees II New I Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles It
Steam Tables
Gravity Furnaces
uspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Z Size f Main 3/q.
Gas Piping Fees IS-0
Tested and Approved .._. .. ! .` .. . Ci"�-' _.......................
D '�E INSPECTOR