1519 ro�14 %1 q I C 20 1 Q�LOT NO �.
NO. STREET . ,
® lC ON FOR GAS PERMIT
0 DEC 21 1961 OF CUPERTINO
CJ Date .N C- 195 Permit No.
CITY OF CUPERTINO Fee $-Q
M 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.
u
u
Use of Premises l/'i//��G':Y -
u
4hone
wner DO/V' �'' l'l /9iv Address
y // /7/t 0' �„6, Address uis td.
CONTRACTOR, AGENT�T Approve
PLUMBING INSP
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas'Ranges
w/all L�eaters � 3 � ��
Circulating Heaters
Blower Furnaces 11
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace 11
1-7
Miscellaneous j I j
Now
(NAMG TYPE)
pp lance Fees�s
Inspectedand Approved ..............:... ...............................................
DATE INSPECTOR
HOUSE GAS PIPING
Numher of Outlets Size Outlets Size of n
Gaj NIpmg Fees
Tested and Approved . ..... .. .6y1...... .. .... .. ...... ..
DA E INSPE 0