2690 NO. ® EET 1
Af L C0 T FO GAS PERMIT
.w i CI P CUPERTINO
Y 0
IJAN 281964
3 U Date 196_ Per No.
w LL CITY OF CUPERTINO Pees
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� Application is hereby made to the City of Cupertino for n 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 Cit}
<w of Cupertino, and other laws a plicable thereto.
I „ Use oPremises
o_ o
' Address
0 3 Owner
za
J //
z ALt, AMEK/L,4N la�o/S. Address /01/i0CV11 % 10A, �D-
3 0 CONTRACTOR,AGENT O S C yC
— Phone 4 '5"7 0 2 2�
oState License 2 3 3 ��sem) Approved
U
a PLUMBING INSPECTOR
✓J
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 GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved �' ..f�.`_T..�.... .. ... .. ___...........
DATF. INSPECTOR