2821 - GAS Zy"4
v
TOT NO.
NO. Sna
W } N FOR GAS PERMIT
a D OF CUPERtINO
Z l MAY 7 1964
0 U Date 196_ Permit No.
= WQTY OF CUPERTINO Fee $ 14 —
0 pphcation is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliancei as listed on the reverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
a W of Cupertino, an*otr s applicable thereto.
Wx
Use of Premises
00
> W
0 3a Own ddress
ZJ
JO By Address
3 f O NTRA O ,AGENT
— 0 Phone
W 2 J
W W 1
oSt a License Approve
`}t PLUMBING INSPECTOR
Nemacks (Check J)
Type of Appliance Units Fees II New Replace Relocate
s Ranges
Wall Heaters
as 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 Main
'Gas Piping Fees
Tested and Approved ........................I................................................
DATE INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
GAS PIPING APPLIANCE FURNACE
9, APT. TESTED AND INSPECTED AND INSPECTED AND
o. NO. APPROVED APPROVED
`JrZ• S-C-
s.
6.
7.
8.
9.
10;
11.
12'.
13.
14.
5
16.
18.
19;
20. i
r
1.
T5.
0
GASOSERVICE NOTICE OFFICE
COPY
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
......................6.. /.5..... —
......... .............1 1964:�
To
,You are hereby authorized to connect the GAS service for
Owner or Tenant
At
New Service ......'.a�...... .......
No. of Meters ..1/.............. Reconnect ..............................
Move Service ......................
No. of Add. Meters ............ Move Meter ....... .............
LUMBING INSPECTOR
°q' I.