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1467 (2) LOT NO. STREET ® I FOR GAS PERMIT OCT 2 �8U1 C bF CUPERTINO Date U� , 195_ Permit No. CITY OF CUPERTIN© Feea_� A a 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 gand/or appliances in accordance with the provisions of the Plumbing Code of the City V of Cupertino, and all other laws applicable thereto. v N_ Useof Premises SES/Od vctr u CUPL'Q ri...0 9.POPrx rirr, tTo. in Owners flN /Q_G4S'S A.(/ Address_,S,4,y_ER.4;v-czrr ,. �By Ca/yfB/✓b Address C1/�rnF!/LL CONTRACTOR, AGENT I O Phone 6?-fr,-1</// Approved PLUMBING INSPECTOR Remarks (Check ✓) Type of Appliance I Units Fees II New I Replace 1 Relocate Gas Ranges I �� \)Vall Heaters Gas Plates 1 I I I Circulating Heaters 1 l I 1 Blower Nurnaces I 11 1 I Gas Fired Boilers I I 1 I Warming Ovens 1 Il I I Percolators II I Griddles 1 II I Steam Tables I II I GraJity Furnaces I I Suspended Unit 1 1 1 Floor Furnace Miscellaneous 1 I lit 1 _ (NAME TYPE) 1 II I I III I I I I II I 1 _ I I III I I PP lance Vees 1 2 0 0�� I Inspected and Approved ..............:...I.............. .............. ............ DATE. INSPECTOR HOUSE GAS PIPING Number of Outlets I ;L I Size of Main 9� GasTan?ApFpsroved Fee�1Z.u�I /��i' I.este . . . . . ..�iL...... ...... . ................................ ! GATE INSPECTOR