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1890 LOT NO. NO: STRERT , IF, NFOR 'GAS PERMIT �' ® OF CUPERTINO 1 � /DateJUL 2,;19V)4' 19" Permit No. �U � CITY OF. CIDP€RTINO I Fee $ '� 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 t: and/or appliances in accordance with the provisions of the Plumbing Code of the City -J of Cupertino, and ill other laws applicable thereto. Use of Premises :a Ii Owner Address By� � � Address/ CONTRACTOR, AGF,NT Phone_OW,2— 3-4/7 7 TApproved PL UMeING INSPE ,R ack (CheckJl Type of Appliance I Units Fees II New Replaced.Relocate Gas Ranges Wall Heaters I I Gas Plates Circulating Heaters I 1 II Blower Furnaces 11 I Gas Fired Boilers 1 I I I N Warming Ovens ^ Percolators Griddles Steam Tables 1 II Gravity Furnaces 1 1 Il Suspended Unit I 1 t II� ' Floor Furnace '1 j I I N Miscellaneous NAME TYPE) 1 1 I I II1 , I I I I II I I pp lance Fees 1 Inspected and Approved ....... ....:_.I.......... ..................... .............. DATE INSPECTOR HOUSE GAS PIPING IMain.. Number of Outlets '0, Size of . . GasPiping Fees _3 Tested and Approved .. . .02�.Z....1....... . .................. ....... ....... DATE INSPECTOR