1984/ 6� '7-q,11 -
LOT NO.
NO. S HET
o PTfION B
ti 'OF
Date 221562
FOR GAS PERMIT
CUPERTINO
Permit No. a
� O —
rcc ,m v
Wiyati,Qiis 161b�UeTeML' City of Cupertino fora 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 ott o laws appl�tole thereto ^
Use of
OwnerC1/, Address
t
By Address
/ C TRACTOR,>AGENI'
Phone % �� / Approve
PLUMBING INIIICTO.
of
�Y/a11 Heaters
Gas Plates
Gas Fired Boilers
Warming Ovens
Percolators
_Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
Inspected and Approved -----------------
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Size of Main
Gas Piping Fees
Tested and Approved .... ....: .....L)..N .................
TATE INSPECTOR