2527 (2) aCN'77
NO. STREET
LOT NO. a(0
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PLC
ATION FOR GAS PERMIT
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63
` CITY OF CUPERTINO
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Date I LI 196 3 Permit No. 7
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° CrI �/ (�[ f 1�oF T[n�n Fee $ O
ITAppO tioMts hereglmade 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 a and/or appliances in accordance with the provisions of the Plumbing Code of the City
a W of Cupertino, and all other laws applicable thereto.
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0 W Use of Premises P>JLf9nrn CP.
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oa Owner Fix (I rne➢ �Mi1r � Address_ C_Qurv'�
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Z By .i1,1.(�tal .�S�trc�Qh-e. Address
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' O NTRACTOR,AGENT --
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02 State Licens C- al 3g5 I Approe
0 f PLUMBING INSPECEOR
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace I Relocate
Gas Ranges
Wall Heaters
Gas 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 a Size of ain I V4
Gas Piping Fees: JAT
Tested and Approved ._ .. .....................
INSPECT00.
C or•P1cF
COPY
GAS SERVICE NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
.............................. . ...... . \............_.
To
You are hereby authorize co ,ct'the
'G erv' for
Owneror Tenant .............. .............. ... W................ .. . .. ..............
At ................ .{,�r..Z .....................----............. ...
.0.. --- -........-...............---New Service .......
No. of Meters .......T.............. Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. Mov fete ..........................
i
LUMBING INSPECT
110 7/61-500