1562.. / l✓/'/ hok,<T _RUN ( If? LOT NO. F7• .
NO. STRE
0 R GAS PERMIT
�I,1MAR 2 D 19 � �ERTINO
Date Permit No. 71
4 CITY OF CUPERTINO Peesy
Application is hereby made to the City of Cupertino for a permit to install gas pipes
nand/or gas appliances as listed on the.reverse side hereof, and agrees to install said pipes
b and/or appliances in accordance with the provisions of the Plumbing Code of the City
V of Cupertino, and all other laws applicable thereto.
a,
N
e
Use of Premises ApE 049-~-r
05 Owner d t r Address
AddressC �—
CONTRACTOR, AGENT -
�✓
Phone — — Approve
9
PLUMBING INSPECTO
Remarks (Check t )
Type of Appliance I Units Fees II New I Replace Relocate
Gas, Ranges I I�
Wall Heaters
Gas'Plates
Circulating Heaters I II
Blower Furnaces
Gas Fired Boilers
Warming Ovens �I
Percolators
Griddles
Steam Tables
Gravity Furnaces �� I
Suspended Unit I �I
Floor Furnace I I�
Miscellaneous
(NAME TYPE)
I I
Ap Ip Ip ane trees I ��
Inspected and Approved ...... .....:...I................................ .............
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I ,'Z I Size of Main I Y
Gas Piping Fees
_J
Tested and Approved ..... .awl./. �......
!TATE INSPECTOR