2433G�
pG �4 • SMEET LOT NO.�`
No APPLICATIOYRV0—'5FkI-SPRM
z` CITY Oz z �1w JUL 24 1963
3U Dat ^� ^• •�+ � tnt 196— Permit No.D
(�q _ f. 1,� IIICI o�
'0 Application is hereby made to the e_j Qf (iUrti, "P rOmii;to install gas pipes.
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i a and/or appliances i ordance with the provisions of the Plumbing Code of the City
a of Cupertino, andI of r laws a icable thereto.
W
w S
Ff
W Use of Premise
00 ,
3 Owner / Address
ZJ
j z By f ` Address
_o
3 %
W i . Phon —
a� State License//Approved 7
PTUAMM 8 ECTOR
of Appliance I Units Fees
TYPE.
HOUSE GAS PIPING
Number of Outlets Size of ain L
Gas Piping Fees
Tested and Approved ......t� .r .. ..........................
�7p,. INSPECTOR
1
Multi -House Gas Inspection Card
Gas Permit No .....................................
APT.
NO.
1.
GAS PIPING
TESTED AND
APPROVED
APPLIANCE
INSPECTED AND
APPROVED
FURNACE
INSPECTED oxo
APPROVED
2.
3.
0 4'
5.
M V'
7.
H.
10.
11.
L2.
1.3.
14.
15.
,1 G.
17.
18.
19.
110,
21.
22.
24.
r'5..
118 1/ 63-500