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2489 a�3a9 /,4,ZicV<' y LOT NO: ?' A AP �ICATION FOR GAS PERMIT U G 13 1963 CITY OF CUPERTINO � �te_IItZS1.11t^ 195_ Permit No..-1L—� — ' t� >S Fee $ \ 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. :a Use of Premises H Owner 1 "� Addres�'V ' "H�c/sc0 By �)/C7 -,`�o�Ut� Address /Joh �6�sC. 2J) cLco� ©Y'e-C> PP Phone A roved PLUMBING INSPECTOR Remarks (Check ✓) Type of Appliance Units Fees I New Replace Relocate Gas Ranges Wall Heaters Gas Plates Circulating Heaters Blower Furnaces Gas Fired Boilers Warming Ovens I� Percolators Griddles Steam Tables �I Gravity Furnaces Suspended Unit Floor'Furnace Miscellaneous NAME TYPE) I I II I I Appliance Inspected and Approved ..............:...!. DATE INSPECTOR HOUSE GAS PIPING Number of Outlets Size of Main— --'^ Ga1Piping Fees Tested and Approved ..... ................I........:...................................... VATS INSPECTOR