599 �(/ •ti.L NO.. jn A' w`-LOT NO.
yPLICATION FOR GAS'PERMIT
F �► i rA
TYI
QOF CUPERTINO
1 JU► ' 1 959 1 lull`'
Date 195_ Permit No.
C Y Or CUPERTINO Fee $ z o
Application is hereby made to the City of Cupertino for apermit to'install gas pipes -
and/or gas appliances as listed on the reverse side hereof, and agrees to initall said pipes
an appliances in accordance with the provisions of the Plumbing Code pf'.the.City 7
of,Cupertino, and all other laws applicable thereto. t ,,
Use of Premises / �• x '
- ``7
_Address '�'. #'l�r+"fa•
CONT0.A O0., AGE T -- '•?' ^
P1 e J Approv
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges I '• , I '
Wall Heaters I k. 11
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
. Steam Tables
Gravity Furnaces
Suspended Unit II
- Floor Furnace
:::,Miscellaneous
NAME TYPE)
Appliance Fees - —��— 1 1
Inspected and Approved ._...........%-1 .........................._ .. ............ i
DATE INSPECTOR
HOUSE GAS PIPING
-Number of Outlets Size of MaiJ
Gas Piping Fees
—�— —
Tested and Approved�� . ?..�.......14
.................._....
DATE ( INSPECTOR