2714 LOT NO. /SJ
E T .
APPPLIC T ON FOR GAS PERMIT
w z FEB 2 8 1964 OF CUPERTINO
x ° � i� . .
° a DrrPrT�r Ynr1`1nIIn -- "' Permit No.
3 LL lr�T�—Ql'J—G��Lf� I I:V,% Fee $
° 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
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
Use of Premises
��(�/�E%✓�� ' /
a a Owner 1��9it'/) ( "/�%/fZ/� Address 4,3
J By � wGE Y C d Address
3 acONTRAcr R,AGENT _ J_
— m Phone
/rev �6c c�
oStale License,/'6'G 9 Approved
n U PLUMBING INSPECTOR
�D ,
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
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Hoor Furnace I
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPI
Number of Outlets )/ kzf ainGas Piping FeesTested and Approved .......... . .... ._......._..._.................
DATEINSPECTOR