898 LOT
�•yO. IJO� STREET t -
f
_ ,APPLICATION FOR GAS PERMIT
LIPITTY CUPERTINO'
n lqm
'Date �1 Permit No.
_9� —iff—?--
Fee $
3�
f`I IPa RTIPI�
Application is hereb'ylmadedo the Cr y 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
N
of Cupertino, and all other laws applicable thereto.
1 a Use of Premises /
! Cn Owner Address
By Address
NTRACrOR, AGE WILLIAM
Phone_OD Approved D. BENE tjr '
PLUMBING INSPECTOR
e
Remarks (Check ✓)
Tigof Appliance Units Fees II New Replace Relocate
Gas'Ranges
Nall{Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gu Fired Boilers
Warming Ovens
Percolators .�.
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit � , ' II
Floor Furnace
Miscellaneous
' NAME TYPE)
III
pp lance Fees i inspected and and Approved ..............:...!.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets y I Size of Main
— F
Gas Piping Fees /
_._
Testi and Approved ���ia. .. . .........._.....
.... ..
....... ...
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nATE INSPECTOR