2687 / 7A',,/g LOT NO.
NO. Si r
N m A, MC ON FOR GAS PERMIT
W i OF CUPERTINO
x o fffJAN 151964
0 ' Date 196— Permit No. C/
u � QQ ,ERTII��
i � C Fee $
O v�}7plica is here y made t 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- and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all ot/ laws applicable thereto.
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r Use of Premise
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3:r Owne[r Address
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zo Address/ ?1 iYj za
3 r CONTRAR, AGENT
— m �PhoneJ-
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o >State License Approved
-U PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees New iReplace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters t
Blower Furnaces , 1
Gas Fired Boilers
Warming Ovens \
Percolators u h ;
Griddles ry 1;1
Steam Tables
Gravity Furnaces Y
Suspeqdej Unit `
Fluor Furnace
r _
Miscellaneous J )
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets I I Size of Nfain
Gas Piping Fees
Tested and Approved ._. . .�� '.I..r. ...`
. .................
DAT I INSPECTOR