457 LOT NO. L._�-
NO. STREET -
APPUCATION FOR GAS PERMIT
CITY OF CUPERTINO
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11 Dat � � 195_ Permit No.�
`1 MAY 7 1959 Fee $ "' 6D
Application is hereby made to the,Cityof Cupertino fora permit to install gas pipes
an p� s a e reverse side hereof, and agrees to.install said pipes
.an jb4�pp ces4lrl t83rktt th the provisions of the Plumbing Code of.the City
of Cupertino, and all other laws applicable thereto.
o
- Use of Premises
y . ,��-- �37,� C�e�-doirJ
,4 /, i Zt:G' Address a�sly>/�it�i
n Owner
BY : " t i-Address
'- •I CONTRACTOR, 'Ac
;Phone P. O.. Box b78 - , Approved S 2,ts tcr..L
f., , unnyvele, �CelIL i PLUMBING INSPECTOR �yur
I
Remarks (Check d) .
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Nall Heaters �-
Gas Plates
Circulating Heaters
Blower Furnaces �-
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables I I I
Gravity Furnaces
Suspended Unit II
Floor Furnace
—I ,
Miscellaneous 1 1
NAME TYPE)
' I_11L-7
II _
pp lance Fees P
Inspected and Approved .........._..:...I................................................
DATE. INSPECTOR
HOUSE GAS PIPING '
Number of Outlets ,2 Size of Main
Gas Piping Fees ,
—�_.
Tested and Approved .... .�3°/f--....�..... . . ....................
DATE INSPECTOR