615 / ' a •r
STRE
v. APP `1 y TION f.OR. GAS-PERMIT`�' --.'
A rt v i
CITY OF CUPERTINO '
Date I � -'I t ;195_ Permit No.
�Applica�on is h cepb ad I ttotthe CSty of Cupertino for a permit to Inst' all 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 other laws applicable thereto.
v
Use of Premises
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Xd
Address •-
hoCONTR CTOR, AGE ApprovedwA&t--.' /
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PLUMBING INSPECTOR
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:: .,��,e .w'v'•.r<:'" 7+ Remarks (Check ✓) .
Type of Apoience Units Fees New Replace Relocate
Gas Ranges �? _
\Vail Heater{I'.'
Gas Plates' r.
Circulating Heaters
Blower Furnaces
Gas-Fired Boilers
Warming Ovens
Pe colators
G'ddles
1\Stea Tables.. • - ��
Gravity Furnaces
S_u pended Unit
oor Furnace,.
Miscellaneous,•;;`
NAME'-TYP. )*,',, .:..
Appliance
!"l-r1,
nspected and Approved ... ........:... ..............................................
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size ;of Main
.. Gas Piping Fees >
—�--
ted and Approved . 7. ."�. .. ... . ... ....._..................
ATE INSPECTOR