51104 �l • r - LOT NO.
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HOS RE9rBYP I ION FO GAS PERMIT
w zMAR u 6 1965 OF CUPLRTINO
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°SiDq 19f� Permit No. /d
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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 N 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.
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4 Use of Premises r5 111 IV GC
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GAnnKC/Ar W. mo.SoQ Wv- Addressg. 13 Ak 9/4 '�nz ,-
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ZBy f��e�a . Senr ire eA.. lwe. Address 451 Queens Lane
O CONTRACTOR, AGENT San Jose, a 1 ornla
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o State License 7/��9 Approved
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PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees II 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