1641 (2) NO. sQ ._ '
VAPR
� R GAS PEMIT
17 19 �UPERTINO
WDate AOA/L /G, 192 Permit No. 1611
Co CITY OF CUPERTINO Pee a
Application is hereby made to the City of Cupertino for a permit to install gas pipes
band/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
M and/orappliances in accordance with the provisions of the Plumbing Code of the City
V of Cupertino, and all other laws applicable thereto.
i Use of Premises /PL-S/DkNLt'
� u
I Owner &aAk1zr14.r Address. LUtl[ PTi vn
�y AJ///Jn ✓ /�t�i Address
CONTRACTOR, AGENT
Phone - Approve
i PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges 1
Wall Heaters I --T
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Tired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit- -11
Floor Furnace
Miscellaneous
�NAMF TYPG)
pp lance ees _
Inspected and Approve .. ..! d .b.. . . . .... . ..
D e INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of M n J/y
Gas PFees 01
�J
Tested and Approved . ..• •. •"'•'•
ATE IN ECT R