602 (2) .
IMT NO.
O. STREET
APPLICATION r
PERMIT
�q ' ' r-• C {'t ti
11 1959 CITY
tOF CUPERTINO
�. _
Date • - 195_ Permit No.
❑ �� ��•
(�.,..`. '�✓. r. LL.,;.`•) fI RTN
Fee $
' , Application is hereby made to the City of Cupertino for a 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.
• a Use of Premises ^'
h O � ss�W _
Address
CONTRA OR, AGEN
I� one I APpro
1
1, PLUMBING INSPECTOR
- Remarks (Check J) .
1 . `Type of"Appliance."..;1 Units Fees I New I Replace Relocate
Gas Ranges I;
" •\K/all Heaters
Gas Plates I I II I I
Circulating Heaters
Blower Furnaces I I
,Gas Fired Boilers I
Warming Ovens I I I
Percolators I I
Griddles I I II
Steam Tables
'Gravity Furnaces I II I
Suspended'Unit - I I II
Floor Furnace II I
I I ' II I
Miscellaneous NEW
NAME TYPE I I II I
I I III I I
I I II I I
pp lance Fees
Inspected and Approved ......... -T-E ._ ..............................................
OATF. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Size of Main
Gas Piping Fees I- � .'
3— — .
Bested and Approved.. I. :
DATE INSPECT
OR••.