2435 `11'\1•, I f L 1'.�nLLr` /-1 LOT NO.
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APPLICATION FOR GAS PERMIT
N a , ' JUL 24 1963 �WCIT'Y OF CUPERTINO
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3U DMTV &V1��.i;Y. , 1.96 Permit No.
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Application is hereby made to the City of Cupertino for a 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 Cite
a w of Cupertino, and all other laws jplicable there o.
Use of Premise
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3 Owner 1 Address
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30
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fState License ��' ' t Approved
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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
Stearn Tables
' Gravity Furnaces
Suspended Unit i._
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets ize of Main
Gas Piping Fees
Tested and Approved . �... .'a. -1' ,. . . . ..
DATE INSPECTOR
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