2471 T.an - LOT NO. Z
4ETICATION FOR GAS PERMIT
AUG 9 1963 . CITY OF CUPERTINO
�T� t1919J63- Permit
Ta�Jr 1
IIN
Fee $ �•.S D
Application is hereby made to the City of Cupertino fora permit to install gas pipes
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.
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Use of Premises Residence
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In Owner_B1OSSOm Valley Romps Address_ 10531 Oranvo.�_ Tree ne
By Amaral Plumbing Address a Alameda
CONTRACTOR, AGENT I
Z7 Phone AS6-3963 Approve
PLUMBING INSPECTOR
Remarks (Check d)
Type of Appliance—I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates I . 1 II .
Circulating Heaters
Blower Furnaces �-
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
$team Tables
Pravity Furnaces
Suspended Unit
Floor Furnace.,
Miscellaneous
(NAME TYPE)
pp lance F es
Inspected a pp e _ . ._ --..-----.....
ATF. .INSPECTOR
H G
Number of Outlet I2j Size of Main Z/
,Gu Piping
i Tested and Approved ........................ ...............................................
DATE INSPECTOR