2203 ` I A LM NO. `
RMA e a1 . FOR GAS PERMIT
z R 5 .. F CUPERTINO F
Mg. 1963 =' D
3 i Date 196- Permit No.
TY OF CUPE�TII� Fee 3
' o Application is hereby ma a to HHe City of Cupertino for a permit to install gas pipes
o i and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
> r and/or appliances in accordance with the provisions of the Plumbing Code of the City
i W of Cupertino, and all other laws applicable thereto.
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J LL Use of Premises00
o i Ownd--X Address/ , — Addre ��-
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W
ox State Licens �GS�G 'yam Appro
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Remarks (Check F)
Type of Appliance Units Fees New Re lace Relocate
Gas Ranges
\VI1 Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Gri es
Steam Tables
Gravity Furnaces
Sgspen a Unit
loor Furn ce
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ......... .. `. . . ... ...................
A INSP a
Multi-House Gas Inspection Card
Gas Permit No. ....................................
1 GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED Axa
NO. APPROVE APPROVED APPROVED
2. .�-
3. �
4.
S.
6.
7.
8.'
Q•
10.
11.
13.
lir
14.
15.
16.
17.
18.
19.
20.
21.
22.
24.
:25. ;
. 118 1/63-300
TEMPORARY ' GAS SERVICE
DATE: .... ... ... .. ................ .....97� Fee: ...............
.
'OWNER: ....--- .........
AT: ./.443.7/...... .. ..... .. .......
LOT: ....- ....................... LJUL 31.1963......
REASON: .----• .. .... . ...... .... ........CtT.y...%...C.jJPERTjr10
The undersi ed to be responsi for the gas service at the above location,
until the di ready for occupancy, and is released by the Building Department,
City of pe
..... .......... . .........
1171/89-500