458 (2) LOT NO. M e) �a
NO. STHHHT
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
Date < . 5_ Permit No:
(�{ tj I MAY 7 1959 D Fee s
' •\ °Application is hereby made to the City of Cupertino for a•permit.to install gas pipes, ,
. . and/or a `gyp es( verse side hereof, and agrees to Install said pipes.;
and/o� p�ank� in htlbMth the provisions of the Plumbing Code of,the City.
of Cupertino, and allotherlaws applicable thereto.
_ Use of Premises /� _': G/�
rtZ Owner Address—
]3Y
ddress
I .
gy ,ti Address
• C NTx CTO AGENT
Phone' P' S' ot'ox �J to �s 1 Approve
PLUMBING INSPECTOR
' Remarks (Check J)
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges
'Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming-Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit j j. II
Floor Furnace I _�
Miscellaneous' _i� ' '�
(NAME TYPE)
pp lance Fees j 11 f
Inspected and Approved ............ _ ........................._.....-..............
DATE. .INSPECTOR
HOUSE GAS'PIPING
Number of Outlets 1 2i Size of Main
Gas Piping Fees �i 1
Tested and Approved ........`. .:u.q/�.�.
DATE INSPECTORS