667 LOT NO.
NO. tez STREET
'APPLICATION FOR GAS PERMIT
T CII OF CUPERTINO
JUL 2ni '959t.
\.I Date J U L E E 195_ - Permit No. W01
OF CUPtR°LINO, Fee $ t 5%
4 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'
v and/or appliances in accordance with the-provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises ✓u-Q-c-�`^�-�-
Owner G
IAddress- _
-
ByHMT Address
11!97 steve
Phone roc ce Santa Clara, CaM. Approved
_ PL SING INSPECTOR �'
Remarks (Check ✓)
,Type of"A'gpliance I Units Fees•I New Replace 1 Relocate
Gas Ranges "'ti i•.. 1 I
all Heaters.. 1 1 I I
Gas.Plates 1 I I 1
--'Circulating Heaters I i
Blower Furnaces 1 / /.�'c 11 I' I
'Gas Fired.Boilers
',Warming Ovens I I
Percolators I 1
G' dles•^
• StTabhes. ! I I I
Gravity Furnaces
Suspended Unit 1 II'.
F r'Fumace 1 II
1__ I •. I • II I 1
;Miscellaneous 1 •' i1
NAME TYPE)���' I �• I?
I I •. II I I
I I I II I I
I I II I I
pp lance.Fees /.1370 I
Inspected and;APProved/(.��.Q..L. -- ...................
DATE INSPECTOR
I
HOUSE,GAS PIPING
A
'Number'of•outlets 1 I Size of Main
Gas Piping'Fees 1 1
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_Tested and Approved .................:...:..1..........................................
:....
DATE INSPECTOR
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