2833 20568'- Stevens Creek Boulevardp,NO,
NO. STREET
W i � AI ION FOR GAS PERMIT _
® OF CUPFRTINO
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3 u Dater (��C -"4 196_ Permit No.
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CI Xpli ion h rc�nade'to the City of Cupertino for a permit to install gas pipes
o < and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
ia` and/or appliances in accordance with the provisions of the Plumbing Code of the City
< w of Cupertino, and all other laws applicable thereto.
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� `0 a Use of Premises Meat Market
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N `?Y' ZR''o- `.:$,' r • Address 690 KingS ROW
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ZJ 1217 Dell A��
Winchester Plumbine Address
O By CONTRACTOR, AGENT
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— m Phone 378-7615
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State License 210245 Approved
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PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance Units Fees II 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 PIPI
umber of Outlets Sile of in
Gas Piping Fees
Tested and Approved ...... ... ... ....... .... _..................... ...
DATE INSPECTOR