51129 (3) G`o / Z �i &4 • LOT NO.
No. STREET
An
® P 1 ATION FOR GAS PERMIT
` TY OF CUPERTINO
wa
f 0 - 2 1966
Y
3 < )ai e 196— Permit No. .fIIC;x�_
W Fee$ �—
0 Application is to 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.
4 Use of Premises �LIJ///i �i �� ��4
00
o Address o/2y01'J L
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zBy�441l�Hoi4��r�o<—C ny,Address
CONTRA OR, AGENT /
3
—
Phone
of
ao State License ,c — '�S/7S Approved
_U I fUMmNG INSPEGTO 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)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ...___......._..__ ..-:. .................._.....................
DATE. INSPECTOR