2521 ` OL 0 I "` k. C' W COT NO.
NO. raeer
A,�PLJOATION FOR GAS PERMIT
z z CITY OF CUPERTINO
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fu211962 :
3 a Date 1962, Permit
No.-
CITY
=LL CITY n� CIIPfA :'t^ Eees
' 0 Appli OF is h r y 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 m and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
Ff
Use of Premises
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aoOwne ) � Address (_ 7w
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Address
° �ONEtTAACTOA, AGT
3 m Phone 3��' ���� '
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State Licens i Appro d
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
as Fired Boilers
arming Ovens
Percolators _
Griddles.
Steam Tables
Gravity Furnaces
Suspendbd Unit
Floor Furnace
Miscellaneous
(NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets Size of h4ain a "
Gas Piping Fees 1 ,$a LI L
Tested and Approved . _..Q . �q/ .1 ..............................
DATE INSPECTOR