2080 LOT No.
11NOV
IC,.A�ON FOR GAS PERMIT
ziC OF CUPERTINO
o 19 1962
6 _ o�o
33 a Date 196_ Permit No.
° �
W LL �� . Q� C�IPERTIO Fee S_
LL W � ion is here y made tote City of Cupertino for a permit to install gas pipes
° a and/or gas appliances as listed.on the reverse side hereof, and agrees to install said pipes
i - -and/or appliances in accordance with the provisions of the Plumbing Code of the City
a Wof Cupertino, and allotl er laws a licabte thereto.
C
Use of Premises
o ° S
3 Owner Address
_0 y �q Pl
z B
0 i / n 19 C/ Address
3W 2
— P n L4 &
//State icense 2 Approve
CONTRACTOR, 4
Remarks (Check 1)
ocate
Type of Appliance Units Fees Rel
II New Replace
Gas Ranges
Wall Heaters
Ga' Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces _
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved . ...'20.-......�. ...........
DATP. ' INSPECTOR