1279 (2) NO. STREET LOT NO.
® T FOR GAS PERMIT
C CUPERTINO
-79
,SFE 9 1961
! Date , 1-42�z Permit No... z
r
CITY OF CUPERTINO ' Pee a /' Sp
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
of Cupertino, and all other laws applicable thereto.
• '�' Use of Premises l ] L, / /���i� /y�
�>� r�Cn Owdc +"".... �,. 'Address
;I v r `L f C L. "
By — Address i.
Phone Approved 1
PLUNar"IIJSPECTo
j
St .
sT7
_ Remarks (Check"y✓.)
Type of Appliance I Units Fees II New I Replace I l}elocate
Gas Ranges I I II
Wall Heaters I I I
Gas Plates
CIr sting Heaters I I
Blower Furnaces I
Gas Fired Boilers I I II I ti
Warming Ovens
Percolators I I
Griddles
Steam Tables
Gravity Furnace
SuU —��—I1I1 I
Floor Furnace I
I II I
Miscellaneous I
(NAME TYPO I I _
II I III II I
II t
pp lance Ices I I II
Inspected and Approved ..............:..............................1 :.......
DATE. INSPECTOR
HOUSE GAS PIPING "
Number of Outlets I I Size of Main I d '
Gas Piping FFees I .SOI
Tested and Approved ........................ . ... ....................
DATE
.......•...•...INSPECTOR