2818 NO. -,�S'[R ET LOT NO.
N JR7� L( ON FOR GAS PERMIT
z z RAY
OF CUPERTINO
7 1964
° Date 196_ Permit No.tf0 l�
3� (� T�/ (�C (� F{� i
� ° I att is o t(�e City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'za and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other I_ KGs applicable t ereto.
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Use of P emises
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� 3 Owne Address
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o By _ Address
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oState icense Approved�Z@OU-14n
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A PLUMBING INSPECTOR
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Remarks (Check ✓1
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas.Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warrhing Ovens
Percolators _
Griddles _
Steam Tables _
Gravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous
.(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of lin —
Gas'Piping Fees
Tested and Approve ... .. . ....I........ . .................................
DATE INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. . ................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED PP VED APPROVED
2.
3
5.
y .
pr�
9.
P0.
11.
T2.
13.
1-4
15.
1.6.
17.
'18.
20.
21.
22.
23.
24.
25. '
116 1/63-500 /