661 (2) ios38 ,fit ', ti 1Q1, . ys
LOT NO. •'.�
NO. STREET a l
f Fi4PPLICATION FOR GAS PERMIT
J JUL G 1�CITY OF CUPERTINO
Date LU C 2 2 1959 195_ Permit No. l
irY a,- cc�Pt� lI Fees —
Application is hereby made to the City of Cupertino fora permit to install gas pipes
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 ,
:a
Useof Premises 14-60 elm.+
in Owner da4.,v� AddressDIV3
gy—p1�RTIPJ�& SkSC T'O1�N Address
17197 Stevemce j O SeAGE
nla ara, kali}. Approved
Phone
PLUMBING INSPECTOR
r Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
',rGas Ranges I I
1 _Wall-Heaters III I
Gas PCafes,
,a Circulahn'g Heaters
,Blower Furnaces
G.11-Fired Boilers
V(Larming
Ovens -
Percolators I
Griddles �, I
Steam'Tables
Gravity Furnaces' I'• I II I
'Suspended Unit
Floor Furnace • .. I II I
17 II
Miscellaneous
NAME TYPE) II I
I I II I I
I I II I I
I I ' II I I
Appliance Fees �[--I —
Inspected and Appm ed l�.-.. .. .= - _.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I I Size of Main I
Gas Piping Fees -
.Tested and Approved .------------...........I...........-.............. ..................
DATE INSPECTOR
o 0
' z z �\
a � �
n o �
a rD
o C7 C7 N
o � �
N
5 o m
C
a . � � m
T fly. 0,.�
m
y
-,r°• .. .. � `ern: