2416 4e!79-6
OO i - `LOT NO.
NO. <j&TIC
t� 4 O'LIC TION FOR GAS PERMIT
a OF CUPERTINO
x o 9_ f JUL 12 1963 r
LL
3 :' Date — — ^•F96 Permit No.
u Gi f tFLIAW
Fee•$
LL
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas app!iances as listed on the reverse side hereof, and agrees to install said pipes
a r and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
ao Use of Premises
o a Owner
S Address
J z By 75 ® Address
_ o
a K
— 0Phone
wz
i o StateLicense Approved' Approved
—L P A
• r \
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)
it I
HOUSE GAS PIPING
Number of Outlets I Soe of ain
Gas Piping Fees '
Tested and Approved .....:... ..... .. ... .�.: �v`�
ATE INSPECTOR
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.
76.
9.
i0.
11.
12.
13.
14.
15.
Y6.
17.
18.
19.
20.
21.
22.
23.
24.
P5.
118 1/63-500