2777 / '• ' LOT NO. 'Ll
N° ® APPLICATION�FOR GAS PERMIT
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W = l APR 17 196q" OPi CUPERTINO
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lA� Permit No.
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° Application is hereby made to the City of Cupertino for a permit to in gas pipes
o < and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i - and/or appliances in accordance with the provisions of the Plumbing Code of the City
a W of Cupertino, and all other laws ap-pllicable thereto.
Use of Premises
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Address
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a / CONTRACTOR, AGyy
3 a' Phone�V 1?Z 39;e 41
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o State License Approved
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—U PLUMBING INSPECTr OFR
Remarks (Check J)
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 Turnaces
--Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets 1 &2 , ize o Main i
Gas Piping Fees ,
Tested and Approved ....._ _ ! .I_ .Ati....._.........................
A E INSPECTOR