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1514 L07-NO. NO. "S'raEET 1 ON FOR GAS PERMIT OF CUPERTINO f'DEC 19196 Date 193_ Permit No. CITY OF. CUPERTINO Fee s; Application is hereby made to the City of Cupertino for a permit to install gas pipes and/or gas appliances as listed on the reverse side hereof, and agrees to install'Said pipes 9 and/or appliances in accordance with the provisions of the Plumbing Code of the City �-' of Cupertino, and all other laws applicable thereto. /t c -CfJy� a Use of Premises 10 Q 40 Owner l tZ Address _ g \Address � C ACTOR, AGEN41, Approved . EI _oI PLUMNGNSPECT Remarks (Check ✓). Type of Appliance I 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 (NA-ME TYPE) Appliance Fees —�� Inspected and Approved .................. ........_.................................:.>.... DATE INSPECTOR ,1 HOUSE GAS PIPING Number of Outlets Size of ai Gas Piping Fees -1 Tested and Approved©.. .... . .................. DA INSPECTOR