2513 LOT NO.
NO. Q STAEET
CI TION FOR GAS PERMIT
w ` ® ITY OF CUPERTINO
o �AUG161963 d� ?
3 < Date 196_ Permit No.�5�'J/3
x o CITY OF G. PFT' i�
wa �� �1 - Fee $ /- SC"
x Application is her made to the City of Cupertino for a permit to install gas pipes
0 , and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
is and/or appliances in ac41aws
the provisions of the Plumbing Code of the City
w of Cupertino, a ot :able thereto.
Use of Pr0 0Owne Address
0z `_j
AlAddress f—
� o N1TtGENT
w Z Phon
w Z
oState Licens� I Approved -
U :PWR
Remarks (Check d)
Type of Appliance Units Fees I .New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates _
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
'Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Mai
Gas Piping Fees I
Tested and Approved ......^..r7I?.:..4 f....... ..... ..... .....................
DATE INSPECTOR