2073 (2) 02 NO. -�
NO. ',.��, �T0. _vim
p 1PL�C 11N FOR GAS PERMIT
NOV s
1962 OF CUPERTINO
Date
Oct. 311 196?--.... 195_ Permit. No.
CITY IIVu 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.
u
C
:a
Use of Premises Reellieneoe
v
Owner Deep Cliffe Dev. Co. AddressJ-
Phon
Lntwa_Ave.
By t{:+P'�+9.�!�, l• �• Address
e Approve
1JUPLV �/{-� {y \•NLSr cf.0\. PLUMBING INSPEC[p0.
Remarks (Check ✓) .
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
\Y/sll Heaters
Gas Plates
Circulating Heaters I�
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
Appliance Fees
andApproved ............. ...............................................
DATE INSPECTOR ~
HOUSE GAS PIPING
Number of Outlets Size 'of Main
Gas,Piping Fees •..
Tested and Approved . .c.. ...................'....
I IrrsrECTOR