51145 A6d , LOOT NO._�Z
N0. REET
ATION FOR GAS PERMIT
w PfAPJROM OF CUPERTINO
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0 �y�//3 UUare' 19 .6— Permit No. 167APJ
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o CATpyca is 4Qq��ef�p f{e City of Cupertino for a permit to install gas pipes
°o a and gas apphanc€s`!�! A�Ie�d bhVAhh 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.
J 4 Use of Premises
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3 Owner Address
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3 0 Phone 3 79���5�� <
a01 State License 2 Q Approved
PLUMBING INSfECTOR
Kemarks (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 Main
Gas Piping Fees
Tested and Approved ..-_.._....................._........._...__.._......_.....----
DATE INSPECTOR