789 `•?i , Ij�C- / LOT NO. -
NO.;. STREET * `J
Aa
ARP ' N FOR GAS PERMIT ti
Is'9T" Qrr � I F CUPERTINO- -
i
Date �CT 221959 �5_ Permit No.
CITY Of CUPERTINO Fee $
• Application Is hereby made to the City of Cupertino fora permit to Instal
and/or gas appliances as listed on the reverse side hereof• and agrees to install said "pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
.,4_• Use of Premises i
JiC.. •ivner Address
By
Address
•• V L, R, AGEN ,
W ILLIA
!:
Phone %t Approved_M D• hcvl
• '} PLUMBING INSPECTOR��
'Remarks (Check ✓) -
Type of Appliance I Units Fees II Niw j Replace I Relocate
Gas Ranges I ��
Wall Heaters �� I
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
"Percolators
Griddles II
Steam Tables II I I
Gravity Furnaces
Suspended Unit I
Floor Furnace
Miscellaneous
NAME TYPE)
.. II I III II III
I I II ter__
pp Iance Fees I II I I
Inspected and Approved ..............:._I..............
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I r I Main—�
_s-J
Gas Piping Fees I
I
Tested and Approved
DATE INSPECTOR
r