2646 I LOT NO. _ C 2 l
NO. �APEE 'QA I N FAR GAS PERMIT
W Z CI �F CUPERTINO
M ° DEC S 1969
0j � 26 � �
3 U Date -�'• ` 19G 3 Permit No.
Cp ^� 00
° Adp'yy��// nn ((�� PC I�_" � Pee $ ��C
hd Xon4;FherMSpmade 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
> and/or appliances in accordance with the provisions of the Plumbing Code of the City
<w of Cupertino, and all rh r 1 ws pliablethere�t
� ,� Use of Premises _ l � �CX/ l�'/.(1X >
00
3 Owner Address
0a
ZJ _
U By Address
3 UrONTRACTOR,AGENT
— W Phone J 7P� — 9 z
wZ
W w j
o State License 7..Z o`C FApproved
PLUMBING INSPECTOR
Remarks (Chedc ✓)
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 QO
Tested and Approved ................. . .._................................. .........
DATE INSPECTOR
ol Multi-House Gas Inspection Card
Gas Permit No. ------ .............................
GAS PIPING APPLIANCE FURNACE
y APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
1.
2.
3.
4.
5.
6.
7.
8.
.10.
11.
12.
13.
t•4.
15.
16
17.
18. \
19.
21.
2 .
23.
24.
25.
118 1/63.500
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