1438/0/ / I GEES rE,cy• �,pi ✓E LOT NO
NO, STREET
® FOR "S PERMIT
IMF CUPERTINO
I SEP 2 6 1961 I
Pate
'195— Permit No
CITY OF CUPERTINO Fee sc!
nApplication is hereby made to the City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
Rl and/or appliances in accordance with the provisions of the Plumbing Code of the City
v of Cupertino, and all other laws applicable thereto.
Use of Premises ACES/ DEA1 C-'
CB:wner i+7/n E LT �!/L f Address Addres LLco, iiP- APP
PLUMPING MS
Type of Appliance Units Fees II
Remarks ( a ✓]�
New I Replace I Relocate
Gas Ranges II
'
Wall Heaters
I
Gas Plates II
Ca—cola Int g Heaters
Blower Furnaces I
Gas Fired Boilers II
I
Warming Ovens I
I
Percolators
Gri les II
I 1
Steam Tables
Gravity Furnaces
I
—Suspended Unit
I
Floor Furnace
I
Miscellaneous
II I
NAME TYPE I I
I I
I
I I
II
I
I I
• ApplianceFe—es a.QO
Inspected and Approved .............. ....
I ...................... ......................... ,
DATE INEPE=R
HOUSE GAS PIPING
Number of OutletsI a I Size Of Main I/t/
Gas Piping Fees I ?, I
Tested and Approved ..........I ... ..............................:.....
VAI INsvecToa