964 LOT NO50h .
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i ION FOR GAS PERMIT
APR 20 1960 OF CUPERTINO
Date 1W-0 Permit No. 6
CITY OF CUPERT Fee s 567
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 accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
a
Use of Premises
in Owner G Address /&),,2 o*'
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By Address
SAN cJV9L=PA Afi TFO
Phone PHONE- CH R_Ag4 Approve�9�-k�j�
• PLUMBING INSPECTOR //0
Remarks (Check ✓)
Type of Appliance. I Units Fees II New I Replace I Relocate
Gas Ranges
%ValTaeaters
Gas ti'lates 'I I 1 I I
Circulating Heaters I II I
Blower Furnaces I1 11I
Gas Fired Boilers I I 11
Warming Ovens I. I II I I
'Percolators I �_
Griddles
Steam Tables I III I
Gravity Furnaces, I I II__ I I _
Suspended Unit I II
Floor Furnace I I
• I II I
Miscellaneous I I it
NOW
(NAME TYPE I I I
I I II I I
II I III I it
I II _
pp lance Fees I I II I�I
Inspected and Approved ..............:...I................................................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Z Size of Main
Gas Piping Fees .S
Tested' and Approved ..,jr'..//w...It ••• • ••••
ATR INSPECTOR