2694 NO.
C' O. STRHET -
IFEB 17A1P�LICAt ON FOR GAS PERMIT
CITY OF '
CITY OF CUPERTINO
l C 1 RT" . �
\, Date 1961','- Permit No. J
1' - --- - -- - 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.
v
a Use of Premises sT (� L� �p�S�O �L -✓"�'y!c 6'7'
S%E LLA/
Cn Owne Address M C.- 4�
�,a RYM,fn/ V -56 All Address .47-0.5
CONTa ACTO0., AGENT
Phone?L /�— 3Approved
�(J PLUMBING INSPEGT00.
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)
Appliance Fees
Inspected and Approved ..............:...!.
DATE. INSPECTOR
HOUSE GAS PI i
Number of Outlets Size of a;n--17 V4j�
Gas ping Fees
Tested and Approved ......1 .. .......�........ ...
..............................
D TE INSPECTOR