51107.1 i LOT NO.�
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(APR 2 g 1966APP*TTYION OF FOR GAS PERMIT
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196— Permit No. 116 71
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o Application is hereby made to the 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
is and/or appliances in accordance with the provisions of the Plumbing Code of the City
u of Cupertino, and all other laws applicable thereto.
0 °o Use of Premises
3 OwneAJ/A Addres '
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o By Address () /
P CONTRACTOR, AGENT
— m Phone 6'���'�/d,l��
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ao State License is Approved
_V / UMAINC INSPECTOR V
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boi!ers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME, TYPE) [7E
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved .. ........._._..- -j ..................... ........................
DATE INSPECTOR