2145 �•�2�1 �_ I
COT NO. NS
NO. STREET
I QTtON FOR GAS PERMIT
C OP CUPERTINO
f JAN 7 1953; ��
Date �/ 3 1943 Permit No. Q2(-54
CITY r 1-1Dr —�
. C ERTINO Fees Z .�
Application is hereby made to the City of Cupertino for a 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 o er laws applicable thereto.
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Use of Premi ~
Vn Owner /� —�` ca.a�29L.r Addr r'
y el
Address
CONTRACTOR, AGENT !/
Phon �`�- 22 Approved
PLUMBING INSPECTO
s
Remarks (Check J)
Type of Appliance I Units Fees II New Replace Rel ate
Gas Ranges
\v/all Heaters
Gas Plates � � ��
CirculatingHeaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace 1 11
Miscellaneous
(NAME TYPE)
I
f
pp Bance Fees
Inspected and Approved ............:.:... ...............................................
• DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Maid.1`— —'
Gas Piping Fees
Tested and Approved ..•....................._
DATE INSPECTOR
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