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1467 (2) LOT NO.
STREET
® I FOR GAS PERMIT
OCT 2 �8U1 C bF CUPERTINO
Date U� , 195_ Permit No.
CITY OF CUPERTIN© Feea_�
A
a 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
gand/or appliances in accordance with the provisions of the Plumbing Code of the City
V of Cupertino, and all other laws applicable thereto.
v
N_
Useof Premises SES/Od vctr
u CUPL'Q ri...0 9.POPrx rirr, tTo.
in Owners flN /Q_G4S'S A.(/ Address_,S,4,y_ER.4;v-czrr ,.
�By Ca/yfB/✓b Address C1/�rnF!/LL
CONTRACTOR, AGENT
I O Phone 6?-fr,-1</// Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace 1 Relocate
Gas Ranges I ��
\)Vall Heaters
Gas Plates 1 I I I
Circulating Heaters 1 l I 1
Blower Nurnaces I 11 1 I
Gas Fired Boilers I I 1 I
Warming Ovens 1 Il I I
Percolators II I
Griddles 1 II I
Steam Tables I II I
GraJity Furnaces I I
Suspended Unit 1 1 1
Floor Furnace
Miscellaneous 1 I lit 1 _
(NAME TYPE) 1 II I
I III I I
I I II I 1
_ I I III I I
PP lance Vees 1 2 0 0�� I
Inspected and Approved ..............:...I.............. .............. ............
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I ;L I Size of Main 9�
GasTan?ApFpsroved
Fee�1Z.u�I
/���i' I.este . . . . . ..�iL...... ...... . ................................
! GATE INSPECTOR
