665 (2) firs°
ror,No. `/9
y ' NO. / '�5T EHTi
' "APPLIC'ATION FOR GAS PERMIT
JUL 24 959 CITY OF CUPERTINO
Date d U L E Y }9 195_ Permit No.
CITY OF CUO Fee$ �
Application is hereby made to the City of Cupertino for a permit to install gas pipes
rand/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,Eind all other laws applicable thereto.
a
Use of Premises %L<�-c-c.
`:",Z . Own ei fl" �t °' e Address
By - ,, . .:'DIVISI®Id Address
Qc&Qjk5bRNiEA4�to.
Ph174 7 evens Creek Rd. Santa Uara, Calif. Approve
one
r P MBING INSPHCTOR
Remarks (Check.0
.1 • T);pe'of7Appliance I Unit's-'Fees' II .
New , ("Replace I Relocate
,Gas Ranges.
Wall Heaters
GasiPlates y
Circulating Heaters +-
Blower Furnaces
Gas Fired Boilers
Warming Ovens I 1 I 1
A 'Percolators
`:. Griddles it A 1 II 1 I
Steam Tables
Gravity Furnaces I t1 11 1 1 '
Suspended Unit
Floor Furnace
II
Miscellaneous
NAME TYPE)
I I II I I
I I II I I
1 1 11 1 1
pp Iance
Inspected and Approved /L0..r/.I... .............................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets 1 1 Size of Main 1
Gas Piping Fees 'j '
Tested and Approved ................. ......1...............................................
DATE INSPECTOR
L