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® APnP�.{C 1 N FOR GAS "PERMIT
APR 171961 OF CUPERTI NOr,�_ ,
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Date �UPER195 Perermit=No. '
CITY OF . M
Fee
Applicahonlls hereby made,to the'City of Cupertlnprfoi''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,proyisi6rs,-of'the Plumbing Code of the City i
r, v of Cupertino,`and;all other laws applicable,there to,:;:
Use of Premises /T E"d/DAAIC K <' ;
a
u
d a
Yn Owner GO/7lHtn.VNr.rarp i?L/Ipl. _ ;'Addr"ess
BY AgAV ddress
CONTRACTOR, AGENT
1 hone f.P-G_ /// I! _ Approved
,p; , PLUMBIN INSPECTOR—
Remarks (Check ✓) I
Type of Appliance I Units Fees IlyNew. I Replace_hRelocate j
Gay' Ranges
Wall Heaters
Gas Plates
.CirMating Heaters I Pil"k
Bloider Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles_.
Steam Tables
Gravity,Furnaces
Suspended'�Unit
Floor Furnace
Miscellaneous
NAME TYPE)�:;,''::`'.`:(I I ♦ Il n!.j ;'.:'S`.': ;�4 11^N.�I'�w..:�' _
"�t�• ,.� °'r .islli" -'�'.4i;d..r.,"�'.',apy.�l.s.,Y,_`Di
pp Iance Fees ' 10'O �—�
inspectedsand Approved -------.��.}�.:_.._..__..--...:..._....:r....--.-.-:.
_fV TDATP.,;�9yK` INSPECTOR
HOUSE GAS PIPING';i
N4mber of Outlets I ,2 "I ''Size"or Main
GasPiping oc,
i —�
Tested and Approved ._.....................L.................._................... ..:..,
DATE INSPECTOR
OFFICE
. w, ,.:COPY
GAS SERVICE 'NOTICE '
BUILDING,-,INSPECTOR!$,"OFFICE
OF CUPERTINO'i } ,
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r e u
TO ;o.r.4-,.B D:d�A3,;,;^r f�vk.' - L _ J,i 1".. •
You are hereby an o zed tg connect the GAS service for - *-�
Owner or Tenante i ti
Q '.+. . v,as'.X31nIYa:g,•a'
At ....�' Q • ��� i n4 Qt ��yo-"," #rl�,S f
:s, �M y �_ L y�PY�1Lh'i lC 1✓� ` t'�i
No. of Meters :�\\ •° t T ' Rq�n' jY�y' i
- -
,. ' Mdyve,,Service ----
-------------------------
No.
....No. of Add. Miers y ?
ov`Ma er ...
((( �M t
j I f 15 t�3 i 1: y
,�``��✓"� � <./ sain �' r( +`-�- PLUMBING INSPEC R
i'