2633 (2) 0"!- nT o. ion
F`r
E APPLI I1.TiIORI FOR. GAS PERMIT
zN OV 13 1963 OF CUPERTINO
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3 a pgrn�•r.r_ �dn'r•nl,n 196 Permit No.
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= LL Fee $ 7 O
O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o Q. and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'za 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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� LL Use of Premises
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3 Owner e"em r.'o Address��/�EC'iiw/O
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— 0 Phone xlEC6—Z62 D
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a --�� Approved 6- ' . Zvi
< o State License ,
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f PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles .
team Tables
ravity Furnaces
Suspended Unit
Floor Furnace
Misceelaoeous
• NAME TYPE)
HOUSE GAS PIPING
Number of Outlets j, �, Size of in
Gas Piping Fees 1.5-11
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Tested and Approved ....... .. ...... "
.. .. .............................................
ATE INSPECTOR