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2672 LOT NO. N ® POMC FOR GAS PERMIT N Q z i CUPERTINO w AN 1 x ° 664 9964TT.IAN 10 19 4 �- ° a Date 196— Permit No. 3u � ( � (�� p p ° App )afion is"Flerek QRFfbTL A'Vity of Cupertino for a permit to install gas pipes 'o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes i m and/or appliances in accordance with the provisions of the Plumbing Code of the City a w of Cupertino, and all other laws applicable thereto. w I Use of Premises 00 r 3 Owner !>J.Q,c'� � !/F�s� Address ZJ z By G.F-OaJLU r Address A'/ /// ° CO RACTOR, AGENT 3 r — 0 Phone20 wZ s State License /&46 Approved < ° �- U PLUMBING INSPECTOR Remarks (Check ✓) Type of Appliance Units Fees I New Replace Relocate Gas Ranges Wall Heaters Gas Plates Circulating Heaters Blower Furnaces Gas Fired Boilers Warming Ovens Percolators Griddles Steam Tables Gravity Furnaces Suspended Unit Floor Furnace Nisce laneous (NAME. TYPE) HOUSE GAS PIPING Number of Outlets I Z ,MoinGas Piping FeesTested and Approved ._... . ...........__................. DA