51145 (3) , � �` �fiv:l✓ LOT NO.—
® S RE
A I ON FOR GAS PERMIT
W Z IMAR 22 ITY OF CUPERTINO
966
IV
3 U "MY OF_� I"— Permit No.
w l���l �l �I OF�F Fee $ —
LL
0 Application is hereby made to the 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
i m and/or appliances in accordance with the provisions of the Plumbing Code of the City
a m of Cupertino, and all other laws applicable ereto.
u I
w �
LL Use of Premises
00
3 Owner Address
oa
__j �Dz By Address
CONTRACTOR, ENT
3 Phone — �S �L
. Z
01 State Licensees � 'Z'3o 'c Approved WILL[ M D. CENEVICH/
a 0 PLUMBING INSPECTOR
—UI,-
Kemarks (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
Tested and Approved _............._.._...,_.:._........ .......... ......
........._...
DATE INSPECTOR