1918 (2) LOT NO.
NO. STREE ,
® A FOR GAS PERMIT
C VOF CUPERTINO
AUG 3 1962
Date t�'�_, 19c2-- Permit No. /q/1
CITY OF CUPERTINO Fee$ A
(� Application is hereby made to the City of Cupertino for a permit to install gas pipes
J and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
` and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
v
c
v
Use of Premises �
,p
Owne !'r'�v*-�e4o' T�+r d a Address
By • Address v -
CONTRACTOR, AGENT
Phone ,41 3�(7 Approved
1 PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance I Units Fees II New Replace_ Relocate
Gas Ranges I I II" . .. I . I- •.
Wall Heaters II:
Gas Plates -
Circulating Heaters
Blower Furnaces1-
Gas Fired Boilers I N
Warming Ovens
Percolators I 1
Griddles
Steam Tables I I I I
Gravity Furnaces I_ I 15
Suspended Unit I II I
Floor Furnace
II
Miscellaneous
NAME TYPE
I I II I I
pp lance Fees ��—
inspected and Approved .......... ... .............................
'ATF. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I a- I Size of Main 1 lye
Gu Piping Fees 1.7 1
Tested and Approved ......I... .. . ..................
DATE INSPECTOR