2198 (2) LOT NO.
NO. 37aEET
?..,'MAR
APP KATION FOR GAS PERMIT
W i CITY $F CUPFRTINO
Y LL 5 1863 Le p
3 U Date 196_ Permit No. ,9 g
_U Y n �+ �p�•,�n Fee•$ �So
' o +fhHDE h�lF/Efld City of Cupertino fora permit to install gas pipes
o` and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'z N and/or appliances in accordance with the provisions of the Plumbing Code of the City
i W of Cupertino, and all other laws applicable thereto.
W
• f
Use of i _
00
W3 Owner A dress_1_a_za o Al. &A6601P,71-4'
0J
z By Address
I
o
3P—'c Phon ®9rz
aState Licen G 1� Approved i-0 �7
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall. Heaters
Gas Plates
Circulating Heaters
Blower urnaces
Gas Fired Boilers
Warming Ovens
Percolators
Gri es
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
.(NAME TYPE)
i
HOUSE GAS PIPING
Number of Outlets p Sip of&ain
Gas Piping Fees
Tested and Approved ...r..1. �. ..................
AT SP TO0.
fA
005.65/l all
'f+Z
'£Z
'ZZ
TZ
'OZ
'6T
'at
LT
'9T
'ST
Tl
'£I
ZT
_r_T T
'OI
'6
. B
'L
.9
'S
'6
- 'Z
'T
03AOaddY 03AOaddY 03AONddY 'ON
ONr03.3dSN1 ONtl 03103dSN1 ONtl 031S31 '.Ldtl
3�tlNllOd. 3�NYIlddY ONldld Stl0
.................................... .Oji altmad 990
pig uoi4sedsul sog asnoH-.141nw