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C'J1 .%OC N FOR GAS PERMIT
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X VJUN 17 196a fid' OP CUPERTINO
xo 6/15/64
3 'a Date 196_ Permit No. ���
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� Application is hereby made to the City of Cupertino For a permit to install gas pipes
o a 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
i w of Cupertino, and all other laws applicable thereto.
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a Use of Premises Restaurant
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Owner Rhodes Const. Address 690 Kings Row
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z By Win chester Plumbing Address 1217 Dell Ave.
0 CONTRACTOR, AGENT
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Phone '178-761 S
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w 210245
o �State License . Approved
—(0 ) ANNZING�INSPECT� 0R
Remarks (Check ✓)
Type of Appliance Units Fees New I 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
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Miscellaneous
(i AME TYPE) -
HOUSE GAS PIPING
Number of Outlets I Size of M, ain a
Gas Piping Fees
Tested and Approved .. ..flr. 'LJ,...PC ?PrC—' ........
DATE "s To,
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