100092 LOT NO.---
NO.
O. _NO. STREET
z PL GTTION FOR GAS PERMIT
w i ® CI F CUPERTINO
/JUN 23 1966
0 ' � Permit o. � d d 9
3 u Uate t98— N
W W �/ /�r Fee•$ '—
° �IitatiAdhs h t City of Cupertino for a permit to install gas pipes
`o a and/or gas appliances as IisTe��dtth reverse side hereof, and agrees to install said pipes
im and/or appliances in accordance with the provisions of the Plumbing Code of the City
4 W of Cupertino, and all other aws applicable thereto. \
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Use of Prem;-
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0 3 Own {e "6 Address�a7 �libJ£•.S l�K At4C
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CONTRACTOR. AGENT
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U tate License Approved
PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees I New I Replace I 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 .... ........._._...--r_--......_-.....
._........._...._..._...
DATE INSPECTOR