2490 LOT NO. V
NO STREET
® UP ,ATION FOR GAS PERMIT
¢,CITY OF CUPERTINO
AUG 13 1963
195_ Permit No. _
CITY OF CU?ERU11' Fee $ I . S a
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
of Cupertino, and all other laws applicable thereto.
v
Use of Premises
in Owner AddressS��
p By 016 se �0 Aj Address I SO O
CONTRACTOR, AGENT
Phone L- 10 4 o b Approved
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees I New I Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates I I
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
,,3ravity Furnaces
Suspended Unit II
Floor Furnace I _
Miscellaneous I it
(NAME TYPE) I II I I
Cks L(G,t-I I I II I I
I I II I I
I i II I I
I I II I I
Appliance
Inspected and Approved ..............:...L..._.._....----........................
_._
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ........................I........... ...................................
SATE INSPECTOR