1943 LOT NO. -NO. STREET
PA N FOR GAS PERMIT
® pO C F CUPERTINO
Date 06 962 957�/_ Permit No. Z �-9
CITY OF CUPERTINO Fee$
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/orgas 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 Cu"pertino;•and all•other lasts applicable thereto: " +
.s e of Premis'es�
Use ��?-' --;'. .�•� t? /�ae�%fit-4+,.£%► -,�. .
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e m : Owner ' Address::- -.�'.J•» a�cr�X_
By Addres ci�� t
CONTRA OR, AGENT
Phone Approved
PLONKING INSPECTOR
Remarks (Check 0
Type of Appliance' I Units Fees II New . j`Replace j Relocate
Gas Ranges
Wall Heaters j I jl
Gas Plates
Circulating Heaters I I jl
Blower Furnaces
Gag Fired Boilers j
Warming Ovens j
Percolators
Griddles I I II I j
Steam Tables I� „ I
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous I ij I
(NAME TYPE) j II
��� II I Imo►
pp lance ees —�(-- "°'v:
Inspected and Approved ..................j..............
........_................ ....
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Size of Main —
Gas Piping Fees I '9 .)l
Tested and Approved ...(. c. �' * •• . •
DATE TNsPSCT.
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