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A�PPLI !1�1�
N FORGAS PERMIT
a ® OF CUPERTINO
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3U e$1) Y ,FEN , .__, 196_ Permit No.
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O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o Wand/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
< of Cupertino, and all other laws applicable thereto.
Use of Premises /CES/�C/✓n�
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,50 - - U/19R� �PCJ/Li Address
3 Owner
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CONTRAEV L Address 7lf t�O�� r��El/✓
O OR,AGENT
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— m Phone
io State License /G�99� i Approved
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Q PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters _
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace
_Miscellaneous
(NAME. TYPE)
I W-1
HOUSE GAS PIPING
Number of-Outlets 1 Si of Main ,_/
Gas Piping Fees l.�n
Tested and Approved .._. .. .. __..._................
T INSPECTOR