2673 (2) LOT NO.
N EE
N ® APL A FOR GAS PERMIT
f Z JAN 14 1964c1oP cuPExTfNo
x ° JAN 10 1964
3 U Date 196— Permit No.
_
W OF CUPERTiND Pee.
LL
� 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 N and/or appliances'in accordance with the provisions of the Plumbing Code of the City
a of Cupertino, and all other laws applicable thereto. -
w
LL Use of Premises
00
Owner Address LN(j//Jf'/27�—//t/6
z By �2o(Vet en Address / /T//
0 ONTR CTOR,AGENT
3 Q � Yc�Yo
— Phone
W Z
0 a State License C' �'� I Approved
U PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Will Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit G
door Furnace
Miscellaneous
' NAME TYPE)
HOUSE GAS PIPING
Number of Outlets _ ize o Main
Gas Piping Fees
Tested and Approved _..... -. .��_\ ... . ... ......................
DA [NSPECTOa