144310,23/ I /JES7EP�/ n riI/E LOT NO.
NO. STREET
®jaqTtf 10 FOR GAS PERMIT
UPERTINO
f SEP 2 6 1961 �,�
Date 1 Permit No.
a CITY OF CUPERTINO Pee:
Application is hereby made to the 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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
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Use of Premises ,PES/DFNC E
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ro
OwnerCOrni7LI /Z. E,gLTy Bd/LQ pr AddressS TOS
By L M / Address C' 1
CONTRACTOR, AGENT
I Approve
I PLUMBING INS' R
of Appliance I Units Fees
Gas
Miscellaneous
(NAME TYPE)
Inspected and Approved ......... .....:...
................
DATE. INSPECTOR
,HOUSE GAS PIPING
Number of Outlets 'Z Size of Main 39
Gas Piping Fees I.:?,
—�_._
Tested alid Approved ...,/...%. �Z�..........................................
DATE INSPECTOR