2669 LOT NO. .
sTR s
?JAN 8 7J� I*OF
N FOR GAS PERMIT
CUPERTINO
D , 19ey Permit NO. 6
6
0
Fee$
Application is hereby made to the City of Cupertino for a permit to install gas pipes
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
of Cupertino, and all other laws applicable thereto.
Use of Premises /`�✓i�E✓l6
�uq /�
Si
Owner L�L�/ "� P O"p
mss' Address Z10k?,04"I4le-f�tLer..✓i.
By Address�'�E. ErEsn✓.�'�
CONTRACTOR AeRlli
�f Phone 9V� e�Oo Approved 6, 2,
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance I Units Fees II New I Replace I Relocate
Gas Ranges I I II I I
Wall Heaters
Gas Plates
_.Circulating Heaters I I II I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators I I I
Griddles I I I
Steam Tables
Gravity Furnaces
Suspended Unit I I II
Floor Furnace
I I II I
Miscellaneous I I iI I VIEW
i
7NAME TYPE) I
pp Iance Fees
Inspected and Approved .............. i - ------------........................---
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets 12 I Size of Main
Gas Piping Fees /SO
Tested and Approved ---s . :z2 .. -I-/.. �........................
DAT L, INSPECTOR