1808 LOT NO.
Na D A T FOR GAS PERMIT
JUN 2 0 1968 CUPERTINO
Date � � .Z Permit No
&P
Fee $. G�^�— _
do 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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
u
:a
Use of Premises—3 5� ;ZJ yn
u
Cn Owner A 1 H Address
B Gf .•i t Address d-'
r.., CONTRACTOR, AGENT
Phone — - Approve
PLUMBING INSPE OR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Htaters
Blower Furnaces 4 ��
Gas Fired Boilers
WarmingOvens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit, II
Floor Furnace_
I I I
siscel;eneous..,, � I _
(NAMF. TYPO
� II
pp lance Fees
Inspected and Approved.................. ................................................
DATE. INSPP.CTOR
HOUSE GAS PIPING
Number of Outlets Size of lai
Gas Piping Fees
Tested and Approved G41.. . . ....._.......................................
AT: INSPECTOR