51104 ror r:o. _
NO. ft1966
AM!15
N FOR GAS PERMIT
w z ® OF CUPERTINO
FEB
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: Uate 196— Permit No.
041TXica0f is4ibrHb4leta4he 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 m and/or appliances in accordance with the provisions of the Plumbing Code of the City
i m of Cupertino, and all other laws applicable thereto.
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Use of Premises
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3 Owner Q /'r Address--\10,SBl
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0 CTOR, AGENT
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02 State License ybP Approved
YPLUMBING INSPECTOR /
Remarks (Check ✓)
Type of Appliance Units Fees I� 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 I I Size of Main
Gas Piping Fees y/ �j
Tested and Approved -...................... ...:----_............. ..............._...
DATE. INSPECTOR