611 k .}.r Lor No.
NO. yrs ...
��,y,`AP,PLICATION F* GAS PERMIT
J, ulan
t "i W CUPERTINO /
�� • � i all. ;,1959 ,IUj �,. • f� ��
Date• 195_ Permit No.
CU ERTII40 Fee s / s�
Application is hereby made to the City of Cupertino for a permit to install gas pipes.
and/or gas appliancesas 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.
v
Use of Premises /'—•
�n Ow
a Address
_CONTRA TOR, AGr T �/
Phone Approved,M7 `7L�,r d-cr.>/ aa—'
LUMBING INSPECTOR
Remarks (Check d)
Type of Appliance I 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 Furnacedt
Miscellaneous
NAME TYPE)
pp lance Fees �� I
Inspected and Approved ......... ....... ......................................
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Z Size of Main
Gas Piping Fees � ) `�j
Tested and App— roved.'71 /9fI .... .
VATE `/ INSPECTOR