2806 d✓� / LOT NO. U 7
Q S EE p
® q
PP
CL C Tot N FOR GAS PERMIT
2 r7
W z 'APR I 1964E OF CUPERTINO
s0
Y °
� LL Da° a Da C 196 Permit No.
3
Fee.$_1,.J
rf
° Application is hereby 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
i a and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
w x
0 LL Use of Premises
o_ o
> N
o
a Owner ddress —5--le
zJ
zBy / Address,l'��
30
— C R,&N
m Phon
W
W W State License / /J�.�/�� Approved
¢ a
i O
r� U P UGfBIN INSPECTOR
A
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
J i
Miscellaneous
(NAME. TYPE)
HOUSE GAS PIPING
i
Number of Outlets Size of Alain
Gas Piping Fees / - 4
Tested and Approved ._.. . .. �.iIL./ �.'�-�.- ...............................
.Z ATE INSPECTOR