2215 /D O / _ it 'i`v?•LOT NO.!d
rMA
'iCA7IOiJ FOR,GAS PERMIT
9 1963 c OF CUPERTINO t
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3 a Date- f _ p 1r9�6 0 Permit No. r1W_
=a I riml Fee•$ 3. 90
' o Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i s 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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Use of Premises
00
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� 3 Owner n.�_ Address !
B 7�
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Address 1,�re,�O20
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— 0 Phone e
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0 State License / Approved
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Remarks (Check ✓)
,• Type Of Appliance Units Fees II New Replace Relocate
Gas'Ranges
Wall Heaters
Gas Plates -
Circulating Heaters I
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 f Size of n
Gas Piping Fees
Tested and Approved 10 aq ,. -
.........................
DATE INSPECTOR