2602 1pa& ID 4. LIFFG
LOT NO. -
NO. REE
A PPLLCA ION-FOR GAS PERMIT
w C t 'OF CUPERTINO
xo OCT 2 9 1963
0 ' Date 1l' X 7- 6; "3 196— Permit No.
W_ LL
CITY OF CUPERENO Fees a- 00
� Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i H and/or appliances in accordance with the provisions of the Plumbing Code of the City
< W of Cupertino, and all otcher laws applicable thereto.
Use of Premises s ����L •-�
00
r 3 Owner r'�/• C���C-� Address
o <
ZJ
�
z BS7Zy S p 9 - Address �7�/�/�%�-C�•--
3 f CONTRACTOR, AGENT
- Phon 73oWz
p // (/
0 E State Li ens `� Sb/ /Y I Approve
< 0
PLUMBING INSPECTOR
I
Remarks (Check J)
Type of Appliance Units Fees New Replace Relocate
Gas 'Ranges
Wall Heaters
Cis Plates
Circulating Heaters
Blower Furnaces Q
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous '
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets I I I Size of
Gas Piping Fees 7 •rj �� � .
Tested and Approved ._..a l ....
... ..........................................
/Dn \ INSPECTOR _