51064 (2) 24VA9 t of& gy LOT Nn.
N FOR GAS PERMIT
z ` ® OF CUPERTINO
Fg SEP 16 1965
r< _ S/oG�/
30 I� CITCUPERTINO96 Permit No. .
w Y OF Fee She
o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o
and/ gas appliances as listed on the reverse side hereof, and agrees to install said pipes
r : and/or appliances in accordance with the provisions of the Plumbing Code of the City
wof Cupertino, and all othW1a s p liylble thereto.
Use of Premises (, hf SyA• ;%o G
00
3 Owner ��0[ Addresses Z �e; R-R P 0T
ZJ
Z BC� Address
� NTRACTOR, AGENT
a 0 ��_W; a
— m Phone.
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a yo , State License Approved
\\ PLUMBING INSPECTOR
Type of Appliance Units Fees Remarks (Check -1)'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)
HOUSE GAS PIPING
Number of Outlets V, Size of Main
Gas Piping Fees
Tested and Approved .......
DATE INSPECTOR