1638 (2) .LOT NO.
NO. STREET
ft
1 FOR GAS PERMIT
CI CUPERTINO
APR'171962 ryry
Date .�W11 A/ , 196.2 Permit No. �63/J
CITY OF CUPERTINO Pee $ i6,!
Application is hereby made to the City of Cupertino fora 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 &-l/ --Wz/ L�
u
n Owner Address ef&?0r-4rIA"o
�By Address 4–
CONTRACTOR, AGENT I I
rl Phone 7 -67/ Approve
d-
2161 PLUMBING INSPECTOR
t
Remarks (Check ✓)
Type of Appliance I Units Fees II New j Replace j Relocate
Gas Ranges j j jj j
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
GriIldles
Steam Tables
Gravity Furnaces
—Suspend d Unit
Floor Furnace j
Miscellaneous
NAME TYPE)
pp tante ees
Inspected and Approve . ...... ....:...I... .........................,
TP. INSPECTOR
HOUSE GAS PIPING
Number of Outlets A47Le of a j�
Gas Piping Fees j
Tested and Approved .. . 40Ai y..�.. . . . ..............................
INSPECTOR