2216 / ...� t r LOT NO.�L✓G• l \ /•
tv aE =IGATION FOR GAS PERMIT%
a CFIY OF CUPERTINO
x o �IMAR 2 9 1963
3 a Date 1963 Permit No. a�/4�p
U
CITY OF CUPERTINO
= a Feer$ 3" ..30
' o Application is hereby made to the 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
i
Remarks (Check J)
Type of Appliance Units Fees I New Replace Relocate
Gas 'Ranges
Wall Heaters
Gas Plates
Circulating Heaters
.Blower Furnaces
Gas Fired Boiler.
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace i
Miscellaneous
(NAME TYPE
HOUSE GAS PIPING
Number of Outlets-1 Size of Main
Gas Piping Fees 1150
Tested and Approved ./.0--,,-z-./ ).... . .. . ... .............................
DATR INSPh R