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APL ION FOR GAS PERMIT
w z 'FEB 8 1966 TY OF CUPERTINO
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1964 Permit No.�J il, O 7 /
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0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
'o 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
<w of Cupertino, and all other lavas applicable thereto. �y
Use of Premises ( C O/v��Vle/?c,y L1/
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3 Owner �� L Address
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O CONTRACTOR, AGENT
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— 0 Phone '2 SS 1 - z.33 C
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0 oa ate License Appro
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—U 5. —Z O PLUA101N, INSPE
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GASMING
Number of Outlets I WA Size of Main
Gas Piping Fees Ir
Testedand Approved _......._.........._. ._......_............... ....................
DATE INSPECTOR