1342 (2) ao 95S PfP r T,PEE LOT NO.
t NO._ STREET
L I ION FOR GAS PERMIT
® OF CUPERTINO
JUN 16 1961
• Date 195_ Permit No.
CITY OF CUPERTINO '
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
V of Cupertino, and all other laws applicable thereto.
v
f ' = Use of Premises /Q�S/OrN ccr
t ,
( OwnerCO v t/N 4?4,0,1?1< _ Address a t _
UiPedez Z-Itt Address--:;I"""" BMJ
CONTRACTOR, AGF.NT
-Phone 1' >e-rF->< Approved ` k~'
�._ ) PLUMBING INSPECTOR.
G .
Remarks (Check,--7-)--
Type
CheckJ-)Type of Appliance I Units Fees I New : Replace Relocate
Gas Ranges _ • I I
Wall Heaters , I
Gas Phtes :`; �.• I •• I:•'�t:-IL�, I I,
Ciradatirig Heaters
Blower Furnaces I I II I-
, Gas Fired Boilers
Warming Ovens.
PercolatorsI'..
Griddles - I
Steam Tables
Gravity Furnaces
Suipended.Unit.: , .z
Floor Furnace
I I II
Miscellaneous .• I I i I i
(NAME TYPE)
I I II I I
I I II I I
pp lance FeesJ- 1 ,2;oull
Inspected and Approved _............:...'. ......................................
� •:'
DATE .INSPECTOR -?'(1
HOUSE GAS PIPINGy
-12. 3
N
Gas Piping.Fees 12.O
Tested and.Approved -.D. ./�/_L.... ...... '.'.-.
')ATE INSPECTOR rW