1647 (2) 19726 All,(kr Td^, LOT NO. 1
NO. STREET
Q
® ►T FOR GAS PERMIT
�.4�f APR 2 4 1962C , F CUPERTINO
Date �P,PrL 20 t9�?- Permit No. Ab T
CITY OF CUPERTINO Fee s C
T Application is hereby made to the City of Cupertino for a permit to install gas pipes
nand/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 X&YxDd'NCr
u
h Owner Address—
By t N Address- L
CONTRACTOR, AGENT
Phone �7fr—fr/ Approved
PLUMBING/NSPE 0
Remarks (Check ✓)
Type of Appliance I Units Fees II New 1 Replace I Relocate
Gas Ranges 1 � �� I I
Wall Heaters
Gas Plates
I II
Circulating Heaters I I II I
Blower Furnaces
Gas Fired Boilers
Wrming OvenI 1
Percolators �
1
I
Griddles � 1 �l 1
Steam Tables I I II
Gravity Furnaces
Suspended Unit I II
Floor Furnace
L T 1
Miscellaneous 11
(NAME TYPE)
I I II I I
I I II ISI
pp lancelance Fees�l 11 l lII
Inspected and Approved ..............:...1................................................
DATE INSPECTOR
HOUSE GAS PIPING
Number-of Outlets Q�Size of Main
Gas Piping Fees 1
�>
Tested and Approved ..�.... ......... _ ........................
DATE INSPECTOR
FL
PTI
z \ r)
r) m
. 0
r)o
�