1444 /0.Z5'/ I Wzl-s r" / 19oe1l/E LOT NO. �J
• NO.^ STREET �s O
&ISEP
R GAS PERMIT
In 2 6 199VUPERTINO
I. ,
Date , 195_ Permit No.
CITY. OF CUPERTINO oa
c1 Fee
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.
v
c
:a
Use of Premises &JAS//JENCE
OwnerC4/'Ji+7ONLJEAL TH BUiGDE� AddressSA OSE
B PU y PLUM Address CA LL
�/ / CONTRACTOR, AGENT
Approve
PLUMBING INSPE O
Remarks (Check ✓1
Type of Appliance Units Fees II New Replace I Relocate
Gas Ranges
\Nall Heaters
Gas Plates
Circulating Heaters li
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit I
Floor Furnace
Miscellaneous
(NAME TYPE) I I III �I
T
pp lance Fees 1 a? 0011 I
Inspected and Approved ..............:...I...............................................
• DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets a Size of Mair
L-LTested
Fees Ja, 00
pproved ... . .. .,fo3 �...... . ... . ............................
DATE INSPECT00.