1944 1= l z �`2iCv✓� •• r LOT No. -
NO. STIJEET. t 1 .,
ION FOR GAS PERMIT
OF CUPERTINO
T JAUG a 1962
Date �o ,' 195_ Permit No.
CITY 4P CUPERTINO Fre s /7 so
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 other laws applicable thereto.
Use of Premises
o f+
m
iq Owner a_... ;Address
By Address
CONTRACT R, AGENT
Phone Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II N wN-j,lieplue I Relocate
Gas Ranges T��►'
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces II _ I
Gas Fired Boilers
Warming Ovens I a;
Percolators Pas
Grid les
Steam Tables
Gravity Furnaces I ;'':,,"? ,,Iy1 •
`Suspended Unit "
floor Furnace
'
Miscellaneous y
�(NAME TYPE '�'n. '
t II
smell I _
Appliance Fees
Inspected and Approved .................. :�•w ii....
DATP. rtINSPECTOR
HOUSE GAS PIPING.:
Number of Outlets I I Size of h In
Gas•Piping Fees V;?sD1 xv
Tested and Approved ..... .......
DATP. INSPECTOR
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