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614 i LOT NOAEC NO. a5• HflT PT ' ION FOR GAS.,PERMITt�` 'f :L•• 7 T OF CUPERTINO—-- - I Date a Y pp Application is herebymadelto•the City of Cupertino Fora permit to install gas pipes and/or gas appliances as listed on the rrev`rseoide 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. u Use of Premises u �C� is in Own acs Address CONTRALTO , AGENT Phone Approv �if 1_&c PLUMBING INSPECTOR Remarks (Check ✓) Type of Appliance I Units Fees I NewReplaceRelocate Gas Ranges Wall Heaters ,Gas Plates Circulating Heaters Blower Furnaces f� Gu. Fired Boilers Warming Ovens Percolators Griddles Steam Tables Gravity Furnaces Suspended Unit Floor Furnace Miscellaneous (NAME TYPr) Appliance Fees I I Inspected and Approved ............. ........................................ DATE INSPECTOR HOUSE GAS PIPING Number of Outlets Size of Main-�nGGY Gas PipingLees � .� —=-- Tested and roved .//. .... .�...._�.. _.. . . . ...................... DATE INSPECTOR