2218 LOT NO. L-D� / l
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® 14; PL19 A R GAS PERMIT
d z fel{MAR 2 9 19 OF CUPERTINO
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30: Date HdkG�rd6COT,R3 Permit No.
Fee $ .3. 96
O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i m and/or appliances/in accordance with the provisions of the Plumbing Code of the City
a of Cupertino, and all other laws applicable thereto.
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Use of Premises
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J z By Address /,2-;Z-3d S—,6W,1—/
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02 State License Approved
-U - LUM IN�G INS�PE�R
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
'Circulating Heaters I
Blower Furnaces 2
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
i'discellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of n
Gas Piping Fees 3,
Tested and Approved /. ..Z . .... . ... .... . ..................................
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