2417 •, �`( t$ /SPflh_�t�.if/i �iLY/f.'!/ //� LOT NO
yNO: 6] NS�TRERT II'• —T— /
U� APL1�CArT ON FOR GAS PERMIT
z ` JULIA�Y OP CUPLRTINO
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t .12 1963
w X
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° a Date — — / f ^-^^—•-•r196L Permit No.
3u u �I ur uurcm
iFee $_
° Application is hereby made to the City of Cupertino Cor a permit to install gas pipes
'o a 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
a w of Cupertino, and all other laws
lawns aappplliiccable thereto.•
0 w Use of Premises
00 � 1
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0 3 Owner Address
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z By 7,4 (O i Address 7�
o I CONTRACT R, AGENTp
3 w Phone —Cq
w Z —'
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State License �� Approve
PLUMBING INSPECTOR
_ Remarks (Check J)
Type of Appliance Units Fees II 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 I I SlFe of Main
Gas Piping Fees
Tested and Approved .. .' .. _
PECTOR
Multi-House Gas Inspection Card
Gas Permit No- --------------------
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
1.
2.
3.
4.
6.
7.
8.
9
10.
11. —
12.
13.
14.
15.
16.
47.
.18.
1).
20.
21.
22.
•23.
•24.
25.
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