1639 / 0,2 Fs— Iyl exlSryl'. L /J/J/I1t, LOT NO.
NO. STREET
® l FOR GAS PERMIT
C F CUPERTINO
1S ,APR 17 1962
1 Date /Z , 19dt2 Permit No.
CITY OF CUPERTINO Fee a �?
ti 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
v of Cupertino, and all other laws applicable thereto.
Use of Premises /1
u
I / h
Owner—ifA.PeAr.,vil 0.Pv/rkTi<J Address Z4,tlO"Tivo
�!O ray /VL Address L
��4 e 'd CONTRACTOR, AGENT
Phone —k/// i Approved
PLUMBING INSPECTOR
Remarks (Check d)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces I �F
Gas FiredBoilers
Warming Ovens
Percolators
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous it
(NAME TYPE) I I II
it III II II ._
I II I
I I II I i
pp Iance Fe—es--- ]—�—
Inspected and Approved ..............:... ...............................................
.
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I I Size of ai 1 y
Gas Piping Fees
Tested and Approved ..... .. . . . .. .. .. .. . . . .......................
ATE INSPeCTOa