2494 �(YqV ,/oT NO.
NO. STREET FFF
�� P ATION FOR GAS PERMIT
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GST' ' CITY OF CUPERTINO
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' 0AUG 16 193aate 196_ Permit No.
10
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° CIT I AP!icatVI�s ER6y'made to the City of Cupertino for a permit to install gas pipes
oa and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
im 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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� a Use of Premises
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1- 3 Owner +!- '-TM LL'I�F1�1Lt�' Address
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Phone
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State.License ' '- A
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PLUMBING INSPECPOR.''I'
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 ^y."" rF`.r•
Gravity Furnaces -�"4�'`c('�a:<. :;''�� '
Suspended Unit �•.,g„
Ffoor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS Number of OutletsAPIPING4
knjGas Piping Fees
Tested and ApprovTOR, !' {°``'
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