1465 (2) / LOT NO. /
NVOCT2
APPLICAT FOR GAS PERMIT
+I961CF CUPERTINO
Date NV— Permit No. z��5
I'1 V o 0
Fee
a Application is hereby made to the City of Cupertino fora permit to install gas pipes
n 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
V of Cupertino, and all other laws applicable thereto.
v
v
Use of Premises
:a
Cv,0lR ri.vo Ao9a arirs,Aro.
l Owner-JlA '..,/000S'SE�t�r� Address--X4A,,,E%'.r_vc�
By d v AiF Address r A-
CONTRACTOR, AGENT
Phone �'it—F/// Approve
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of.Appliance J Units Fees II New I Replace I Relocate
GRanges
Wasall Heaters I I I
Gas Plates I I I I
Circulating Heaters
Blower Furnaces
—
Gas Fired Boilers I I II I I
Warming Ovens I I I I
Percolators I I Il
Griddles I I II
Steam Tables
Gravity Furnaces
Suspended Unit I II
Floor Furnace I I _�
II I
Miscellaneous
NAME TYPE)
II II III II I -
I
pp lance Fees 1 2-o WI
Inspected and Approved ..............:...I................INS....PC.._.T0..0...................
DATP.
HOUSE GAS PIPING
Number of Outlets I 2 I Size of Main137Y
Gas—Piping Fees I,2,o o
Tested and Approved . . . lOf....I.... ......................................
Are rNSPHCTOR