1442 6-k5s 7"Al LOT NO.
Np. STREET '
PtfION FOR GAS PERMIT
I OF CUPERTINO �[J
Date (SEP 2 6 1961 95_ Permit No. r T y
n1 g
4t'TV Q f�"tPLRdTtNt Fee$
t 1 cah is d t e City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
�1 and/or appliances in accordance with the provisions of the Plumbing Code of the City
Cl of Cupertino, and all other laws applicable thereto.
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Use of Premises /PEslhZ^y 'AC7,
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OwnerPOmm0.1/WEAL7y BU/LD .PJ'Addres S OSE
EY t u Address ELkOR
G— one fRcoNrancr�/%GENT I Approv
�- PLUMBING INS
Remarks (Check d)
Type of Appliance Units Fees II New I Replue I Relocate
Gas Ranges II I I
pUall Heaters
Gas plates i I III
Circulating Heaters _
Blower Furnaces I I-
Gas Fired Ko—iters
Warming Ovens
Percolators I
Griddles
Steam Tables
Gravity Furnaces II, I
Suspended Unit: II
Floor Furnace
I II I
Miscellaneous
NAME TYPE) I II
I II I i
II I II II II
pp lance Fees
Inspected and Approved ..............:... ...............................................
OATH INSPECTOR
HOUSE GAS PIPING
Number of Outlets I 2 I Size of Main I 3�
Gas Pibing Fees I �,
_J_:�
Tested and Approved . .�,/GL.... .. ............................
DATE INSPECTOR