655 317
• NO. STREET ` � •
a
APPLICATION rF,OR GAS PERMIT
` CITY;OF CUPERTINO
' 1
Date �Uy ? 19593 '-11195 U Permit No.
CITY OF CIJPFRT, Np Fees
Q ".;Application is'hereby made to the 1 o 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 other laws applicable thereto.
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:a
Use of Premises yni-e-re�
v
Owner 10N Address
HEATNGp Address i
17.497_ kwomc .°RSema' ara, Ca Approved
Phone
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance (Units Fees II New Replace I Relocate
Gas Ranges
i'_Wall Heaters
Gas Plates < I I' II I
!; Circulating Heaters I II r I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens. I ^ II I I
Percolators I '
Griddles .r, \, _
Steam Tables
Gravity Furnaces
Suspended Unit e.P,
Floor Furnace,4..
Miscellaneous.,;
- (NAME TYPE
ilk ! I II I I
rf I I II I I
pp iapce'Fees —�—
P
Inspected and Approved%-. `3.9_ I. /&0....................
DATE INSPECTOR
Ik HOUSEGASiRIPING
t4 Number of Outlets' I mo;' I Size ofMain
i 'Gas Piping Fees. I?,
"r Tested and Approved ::.....................L.............................................
DATE INSPECTOR
Rte, AS SERVICE ,N TICS °' `orFtcF•
g +s p .r COPY•-
' I.'LADING INSPECT + OF.FICL
CITY
ig
. s
*+ '
You are hereby authouzed to connect the GA serv"ic fo
21
4.. ,`Owner oi•rTenanE t 6L�` '' ��ff�� '
At . ' .. ......... . .........
New Service .Ll
No. of Meters ----- ............... - 1 Reconnect ..............................
Move Service .......................
r No. of Add. Meters .............. Move Meter ..........................
----------- --- - ------...... -- .............._.....:.........----
PLUMBING INSPECTOR
F 110.6/59-500