2645 LOT
NO.� ''.STREB '
CI TION FOR GAS PERMIT
DEC 6 1963 rT of CUPERTINO
W �H3 Date s196J- Permit No. / ev
w n G. �� Fee'$ —
o Application is hereby 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 a` and/or appliances in actor ante wi the provisions of the Plumbing Code of the City
< w of Cupertino, and all er la licaale t ereto.
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w Use of Premises :
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F ONTAACTO ,AGENT
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oState Licens Approve�
U LUMBING 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 Size of Main
'Gas Piping Fees
Tested and Approved . .....a. ....I�.... .. _. _....................
n DATE INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
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118 1/63-500