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1647 19726 All,(kr Td^, LOT NO. 1 NO. STREET Q ® ►T FOR GAS PERMIT �.4�f APR 2 4 1962C , F CUPERTINO Date �P,PrL 20 t9�?- Permit No. Ab T CITY OF CUPERTINO Fee s C T Application is hereby made to the City of Cupertino for a permit to install gas pipes nand/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. Use of Premises X&YxDd'NCr u h Owner Address— By t N Address- L CONTRACTOR, AGENT Phone �7fr—fr/ Approved PLUMBING/NSPE 0 Remarks (Check ✓) Type of Appliance I Units Fees II New 1 Replace I Relocate Gas Ranges 1 � �� I I Wall Heaters Gas Plates I II Circulating Heaters I I II I Blower Furnaces Gas Fired Boilers Wrming OvenI 1 Percolators � 1 I Griddles � 1 �l 1 Steam Tables I I II Gravity Furnaces Suspended Unit I II Floor Furnace L T 1 Miscellaneous 11 (NAME TYPE) I I II I I I I II ISI pp lancelance Fees�l 11 l lII Inspected and Approved ..............:...1................................................ DATE INSPECTOR HOUSE GAS PIPING Number-of Outlets Q�Size of Main Gas Piping Fees 1 �> Tested and Approved ..�.... ......... _ ........................ DATE INSPECTOR FL PTI z \ r) r) m . 0 r)o �