2302 (2) LOT No.
NO. sTR
Pgl N FOR GAS PERMIT
N V
` IF
CI F CUPERTINO
W �
3 a Date MAY 2 91963 196— Permit No. 362
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i W /� ��p �PFee $ �
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A%Tc�fiO6Fhe�gNGB1J th' City of Cupertino for a permit to install gas pipes
0 W and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
iln and/or appliances in accordance with the provisions of the Plumbing Code of the City
a W of Cupertino, and all other laws applicable thereto.
F �
j W Use of PremisesfL2�
00 �
r 3 Owner Address
Z-1 �/� ,/�//y�/J /
j o B96�t�'"� Address/O Q+oc �• /� f �,
3 CON R,AGENT
hone
W +
0 o State License 6 7� Approved
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PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees II New Replace Relocate
Gash Ranges
Wall Heaters
Gas j Plates
Circulating Heaters
Blower Furnaces
GasjFired Boilers
Warming Ovens
Percolators
Gri dies
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace I
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees �!
Tested and Approved ._-... . .. .� - ----
p E INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
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1',6 1/63-500