51145 LOT NO._�CCL•3
NO. STREET
ON FOR GAS PERMIT
W i F(APR
OF CUPERTINO
4 1966
0 LL
° a Uatc 196_ Permit No.
3 LL CITY lI1'F (���p D7 '^'/� Fee 8 ��
° ApplicaTbn is`fiYrh RldNhd.fhe 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 N and/or appliances in accordance with the provisions of the Plumbing Code of the City
W of Cupertino, and all other laws applicable thereto.
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W Use of Premises
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3 Owner ��' , Address
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Z B - Address
F CONTRACTOR, AGENT
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0o State License O J7 Approved - -
—0 ^�\ PLUh DING INSPECTOR V
Remarks (Check ✓)
Tyle 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
Testedand Approved . ......._..........._ ..........._........_.............._........
DATE INSPECTOR