1985 GAS PERMIT40 (0 6 j a /I k-r4g::�7
NO. STWEET
TION FOR GAS PERMIT
OF CUPERTINO
Dat {min2 3,%2 x'195_ Permit NO. �(!
ee
WpYicaU is Tj
No 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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all othej laws applicaWAereto. . n
Use of
Ownerz /-jA-k-zP/L�-,Z-z Address ---
r
By Addres
CONTRA R, AGENT
Phone a —c// O 71Approve
PLUMBING INSPECTOR
Type of Appliance
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)
Appliance Fees
Inspected and Approved .... -
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved .r 2 ....
TATE
OR
INSPEC