1399 ,2 0 5F,2 /L dPrn T,?ze- L A/V F LOT NO.
NO. STREET
"'
17N FOR GAS;. P,ERIMIT`W,' ''� Y
.0
_,r 'kM
SEP 12 1961
,.� Date�•� " 195_ Permit No.1�� _
CITY�OF�CUP-ERTINO= Fee $
pO
,.� L, . .'ttrE R - -
1 7,\ ;;';`rCApplicatiori:i'Lieby:made'to'the'City of Cupertino for,a permit to install gas pipes'
appliances as listed on the reverse side hereof, and.agrees.to install;saidpipes,..
-and%or'appliances in accordance with the provisions of the-Plumbing-Code.,of-the`City'
s V 'of'Cupertino, and all other laws applicable thereto - _f'` ' ' "'"
`f 1-7
Use of Premises t"NC L' -- "/-{✓ .t, ,
V— Owner ed,4;�WdNivr.Ie7N 1Yt 111 .,,,Address"dress"
By /Li?DY'/L �r iN/ u , Address -m. A .�
CONTRACTOR, AGENT
1hon e /1 's - k/I/ Approve �' t
L�
wl PLUMBING INSPECTOR
•T. r
Remarks (Check ✓) .
Type of Appliance• "I Units -Fees<ll .New I Replace Relocate
Gas Ranges -
Wall Heaters I '
Gas.Plates
Circulating Heaters I ."• '' * _i!'ix;,,,
Blower Furnaces
Gas Fired Boilers..
Warming Ovens •V _tz`"" `�T��
-Percolators.
Griddles ll I I
Steam Tables I I II I I
Gravity Furnaces
Suspended,Unit I I
Floor Furnace
II .w
I Miscellaneous
NAME TYPE) I II
I I I II I I
i
pp n<e J ees I 2'0 o II
Inspected and Approved ..............:... .. ...........
INSPECTOR
-HOUSE GAS PIPING
Number of Outlets I I Size bF Main I ?/y
Gas Pip.ig Fees 12. o o
Tested and Approved
p� / i':INSPE�CT00.