2601 J/• �T I //�✓�+✓ '^ C���LL/N� LOT NO.
NO. 5T.HL
y � 1�7>I •N LION FOR GAS PERMIT
w i ® (,��,wA Gy y OF CUPERTINO
x ° ' , ' OCT 22 1963 �J
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° J Date - 196_ Permit No.
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u n
W 0 �ATYIi 'df Q'PER"N", Fees I
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A hca n is �tereby made to the City of Cupertino for 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
i H and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other laws applicable thereto.
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Use of Premises
O00 Address /�,27-Z
3 xOwner (.. _
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� z X By Address
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io (State License 1 Approved
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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
i
Miscellaneous
'(NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Pees
Tested and Approved/0..' .....-3 . ... . . . _....................
DATE "SPECTOR