51145 (2) orx a 1 r // � d!t LOT NO.��
NO. STREET
P�AMN FOR GAS PERMIT
� d OF CUPERTINO
f ° APR 4 1966
O a Date 1`96— Permit No.
3LL CITY. nF (���p[p p� Fee S
O ApprlcatQ is hftC6yERTJ IDe City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
is and/or appliances in accordance with the provisions of the Plumbing Code of the City
w of Cupertino, and all other laws applicable thereto.
u x
w r
0 LL Use of Premises
00
1 N
� 3 Owne ` Address
oa
zJ
zB Address
o CONTRA�/
LTO , AGENT
Phone 2)
z �/`/ —
ao State License ' .3o 5l7 Approved
11—U
LUN. NG INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees I� 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 Size of Main
.Gas Piping Fees
Testedand Approved __._.._._.......... .__,._......_...... ..._...................
DATE INSPECTOR