2332 (2) 6 C ' M 'LOT NO '1I'
NO. - STREE
IC j�„ N FOR GAS PERMIT
®
OF CUPERTINO
N 13 1963
Date 1 Permit No. '
CI OF CU ERTI6VOPee $
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.
y
Use of Premises
a
05 Own � `�"`� Addre
B Addres
CON ACTOR, A E
Phone_L% Approved
/ I PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units .Fees II New Replace Relocate
Gas Ranges
Wall Heaters
-Circulating Heaters
Blower Furnaces �� r
Gas Fired Boilers
Warming Ovens I Ir
Percolators
Griddles
Steam Tables
Gravity Furnaces
,I Suspended Unit
Floor Furnace
" Miscellaneous iiNow
NAME TYPE), I !
pp lance Fees �I
Inspected and Approved .._..........:...!.
DATE. .INSPECTOR
HOUSE GAS PIPING
Number of Outlets ,� Size of Mai 1T
Gas Piping Fees.��
Tested and Approved ...........t.7 .� --j.r-�.......................
4AT¢ INSPECTOR
GAS SE*RVICE* NOTICE OcFFopy.ICE
BUILDING INSPECTOR-S:OFFICE
CITY OF CUPERTINO '
. .................................... ......... ............. A..
To
You are hereby anth Arid to connect the GAS ce for
Owner or Tenant ..............
... .......................... . ............. . .................. ......
0
At ........
........ .............✓..... . ... ................I
New Service ..........................
No. of Meters ........ .........
Reconnect ..............................
.,Move Service .......................
No. of Add. Meters ....... ......
veMeter ...
Ito 6/63-5 60 PLkU, N ,,NS.,