1636 1D31S' '//C/(19i"p, ' h1;?1yL' LOT No, �y
NO. STREET
�,�►PATION FOR GAS PERMIT
® 4)�.o°'=96��
OF CUPERTINO
36 Date Permit No. 1106
A Fee $ ;?2-
Vi' nEs h9fWNCity 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
V of Cupertino, and all other laws applicable thereto.
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Use of Premises �N S/Oti✓c
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w Owner lvOt?Tivd Ze—dArkr//c Address ebOdBTivo
Address L
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AGENT
' hone - Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas .Plates �� I
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace 11
Miscellaneous
NAME TYPE) I I I I
pp lance Fees II
Inspected and Approved ..............:... ..........................................
.....
DATP. INSPECTOR
HOUSE GAS PIPING
Number of Outlets �. Size of Main 7�—
Gas Piping Fees
—> d
Tested and Approved ..? DATE . ....I...... ................
DATE INSPECTOR