2335 LOT NO.
® PaTv ICA N FOR GAS PERMIT
C TY OF CUPERTINO
JUN 13 1 63
Date v 1944e Permit No.
COY-6F COMM Fee $4 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 1 ws applicable thereto.
V
Use of Premises
ti wAI�WA�sXd3res5� l o
M
� Addres � '
NTR CTOR AGBN
Phoneme j Approved
I - PLUMBING INSPECTOR
Remarks (Check �)
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates
- Circulating Heaters
Blower Furnaces
Gas Fired Boilers
,Warming.Ovens
-Percolators Q .
,Griddles .
Steam Tables'
Gravity Furnaces 1-1 Ir I . I
;Suspended Unit
Floor,Furnace
Miscellaneous
NAME TYPE)
I I II I I
pp lance Fees I P
i
Inspected and Approved ...,..........:_.I.................................... ......
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ...................:.... ..............................................
PATE - INSPECTOR
TEMP'vO/ARARY GAS SERVIC�E] /'
DATE: ..........:.... �3 V
..... ..... ...... - Fee:
---------------------
OWNER: ................ ..
V
AT: ..... .d.
'm>a
` e}
LOT:
REASONS ' /
The undersigned agrees to be responsible ,�or the OF -at i-t..... e location,
until the building is ready for occupancy, and is released by the Building Department,
City of Cupertino.
Phone3--------------
�SIN---S--P--E- x-- . -
CTOR TEN OR. ER
117 1/63-500---------- -