906 i
LW
\1 NO. sTReeT `
LIBATION FOR GAS PERMIT
KA� OF CUPERTINO
rJAN 21 1960
Date 195_ Permit No.
ftr) SO
�y Fee a—1
CITY OF CUPERTINO
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in(p acH�c�oorrddaa)nce with the provisions of the Plumbing Code of the City
of Cupertino, and all C�-Ir
ws applicable thereto.
v 1 `
er
Use of Premises
.a t
v
H Owner 4 fa Address _
i By 16&1—_ Sul Address
ONT�RjACTOR, AGENT
Phone��(� oC^/�00 %APDrOVed2�
'��e
PLUM ING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
Gas. Ranges
Wall i?caters
Gas'Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Stearn Tables
Gravity Furnaces
Suspended Unit
Floor-Furnace
Miscellaneous
(NAME TYPE
Appliance Fees i
Inspected and Approved ........... . ............. .................................
DATE INSPECTOR
HOUSE GAS PIPING
YVumber of Outlets Size of Main
Gas Piping Fees
Approved
......Tested and / // /
INSPECTOR