1529 (2) LOT NO.
• NO. TRI ET s '
APPLICT FOR GAS PERMIT ,
,JAN 25 3962Cf w
AF CUPERTINO
Date I�r��Kf/?/,hYtnre� ^`p�A.-,¢; - Permit No.
� • y
�. Fee $
Application is hereby made to the City of Cupertino fora permit to iristall 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
ofECupeitino, and all other laws applicable thereto.
SUse of,Premises '4n- f NGL' '
'inOwnerCOiYJ/Y/aArtvr��YN ,9LD.Of+ ' Address c' ei int..c
n _ By 0",0Y ?///M ,A/
CONTRACTOR, AGENT Address =, %/� '• rtl. iairi>_
7t Approv
hone
'�
PLN INSP CTO0.
Re marks,(Chedc.:✓•1'`
Type of Appliance I Units='Fees II New .,jYReplace,� Relocate
Gas Ranges
M,!y.`; ,. r
\UaII Heaters I "•I'-
Gas Plates � ��:.=tc•.
Circulating Heaters
Blower Furnaces `' "•
Gas Fired Boilers �.
Warming Ovens
Percolators . I
Griddles
Steam Tables
Gravity Furnaces.'_ ::; I;3; 'III
Suspended Unit
Floor Furnace
Miscellaneous '; ' '•�;:»:'� iI —
(NAME TYPE it"•y, -
.�: ..I:;,�. � ���•.. � � Wit.
4 .-V W
T!
inspected and Approved .....YI;:':i t`l.�-.........................-----
.INSPECTOR
HOUSE GAS PIPIN6""' c
Number of Outlets. , Z Size of Main T I/q_" ..
Gas Piping Fees - I;y,
Tested and Approved ... . .... 1�,N!IIECTOR
DATE