2364 Ll 7 V tp 1 J 1SJ-N t.� r�� LOT NO.
NO
leM WO Ip FOR GAS PERMIT
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JUN 20 196�IIN CUPERTINO
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3d a Permit No.Date
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Fee•S��' •r��
o Application is hereby made to the City 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 a 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.
� n Use of Premises /Y.O.O/mem eo - -
00 .
3 Owner a.>7oGli/I/l/ e.'2 Lt.[ Address—Jfa ; ��f
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z By Y/,M-41 '&vntA Address C ('��r+,��1✓l.Q
nOONTRACTOR,AGENT
3 �
- m Phone 27.9-
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. W
ML WILLIAM
7f-WzWILLIAM D. 13ENEVICH
gState License - j2 Approved
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PLUMBING INSPECEOR
Rema rkso,,Cbe& ✓) �:I•
Type of Appliance Units Pees HINew Rel&Kill Relocate
Gas Ranges xa'. le.,
Wall Heaters I Ak 2
Gas Plates r i; ' ��° '
CirculatingHeaters "4 `•
Blower Furnaces s,
Gas Fired Boilers
Warming Ovens
Percolators
Griddles xF
Steam Tables '
Gravity Furnaces {;
Suspended Unit
Flocs Furnace
Miscellaneous
(NAM TTYPE At IM t
5
HOUSE GAS PIPING
Number of Outlets 2 Size ,of Main ii
Gas Piping Fees yr:f
Tested and Approved .. . ...—s„ .V.. : ..
. ... �. .. .- ::......
DATE rINSPECT
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