NO PERMIT NUMBER //Z6 / I /— /4 LOT No. Z2 g
NO. lREET
N ® 'APPL�ATION FOR GAS PERMIT
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CMI
CUPERTINO
o =,!SEP 20 1966
� -
3 < Uate E1 /V 196 Permit No. /
U CITY 1 Fee $ / �°
LL o� rtRERTU �
° Application is hdr O the City of Cupertino for a permit to install gas pipes
'o : and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i m and/or appliances in accordance with the provisions of the Plumbing Code of the City
< W of Cupertino, and all other laws applicable thereto.
~ Use of
`Premises SGt(/�/., H�.v4 Col. p /,
0 3 Ownef-Ue)-a-A.G� ✓ ✓/J Address��Z�/��/`'p r 6 yl!} CT
?zg�LuLr f}✓L ✓ �/� Addres
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°° CONT TOR, AGENT vvu y o-yLc
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M
a $tate Licens'ez3 0 993-�/ Approved
U �1L�/_ t [7 t6INr INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees 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 .
Tested and Approved .... ...............__.........
DATE INSPECTOR