1549 LOT NO. �a
NO. STREET
® N l*R GAS PERMIT
e 1C❑Icl']' p)jF,[CUPERTINO
Anr 6 IJt1� Eat.
Date , 195_ .Permit No. X.
n CITY. OF, CUPERTINO Pee ate?
Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas 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
CJ of Cupertino, and all other laws applicable thereto.
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6
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Use of Premises o ,zeza ' C Q
rn Owner �SOA7�L_n fhirsio.l °a41 �faAddress Cis iSs�l% —
By 64A4
CONTRACLOR AGENT Address
Phone F P" P— ��� Approved
, PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges 1 4
Wall Heaters
Gas Plates
CirculatingHeaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators 11
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
NEW
Miscellaneous � � i� .
(NAME TYPE) I I I
p0 lance Fees I I II I
Inspected and Approved -------.......:... ...............................................
.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets a Size of Main 3T—
Gas Piping Fees ;?-
-�— —
Tested and Approved . . /O.h........ .... ...........................
ATE INSPECTOR