2827 Z✓� /moi' LOT NO.NO, 0 ft1964 N FOR-GAS PERMIT
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�_ 'JUN 16
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Y 7
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° Ja Date 196_ Permit No.
3 o CITY OF CUP�ERTiNO Pee $
Application is here y made 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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
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of Cupertino, and all other laws applicable thereto.
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a Use of Premises
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< Own1e/s -eG r ss
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O CONTRACTOR, AGENT
3<' Phone 32—
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o State License 7 y3 Approved
0 PLUMBING 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 in
Gas Piping Fees
Tested and Approved ._ . .!.>'P-44 .
DATE fNS"CTOR