51145 CEi LOT N°.-/W
NO. oprITREET
APPLICATION FOR GAS PERMIT
z Z ® CITY OF CUPERTINO
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° /APR 22
0 ] Date 196_ Permit No.
Fee $—,�
° C>' xp�T�{a�hofn q ade to the City of Cupertino for a permit to install gas pipes
o a and/or gad appli�dtei At& 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
<u of Cupertino, and all other laws applicable thereto.
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a Use of Premises
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3 Owner Address
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° CONTAAC R, AGENT /
ao State License ? D' �O� Approve �� /Yd
_U // PLUMBING NSPECTOR /
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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
Gravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ._.......... ....._........... _............
................_..._...
DATE INSPECTOR