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1972 (2) LOT NO. _ NO. STREET ® aTIO I N FOR GAS PERMIT ' OF CUPERTINO Date 'AUC 8 x,11 , 195_ Permit No. Qf� - CITY OF CUPERTINO Fee $ 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. u • � Use of Premises a' v inn Owner - Address_�Das By Address CONTRACJ%R, AGENT .� Phone %Approved; = - '� 1 q um BING''INSPECTOR RemlrkspCheck ✓) .._ Type of Appliance 'Fees Fees New Replace Relocate Gas Ranges Walt Heaters I 11 Gas.Plates I II Circulating Heaters JI Blower Furnaces Gas Fired Boilers Warming Ovens I Percolators Griddles I I I Steam Tables• Gravity Furnaces Suspended Unit •+ Floor Furnace ' I Miscellaneous I I _ II (NAME TYPO I ' it I I _ - II s- pp 1 nce Fees Inspected and Approved,.........q.,..;...L................................... �1.... " DATE INSPECTOR ,« HOUSE GAS PIPING Number of Outlets • I Size of in Gas Piping'Fees I TJ Tested and Approved DA NSPE O w g i. - . {« ' �• � . ■ � � � . nG (A 92q . \�Je�",Nlgy � j � < 3- eO C) # § » r m � . . 40