616 Lor No�
NO.1 arne
`'7;� ?,APPLICATION F ' GAS PERMIT
CITY OF CUPER INO
,t J�,1 _ t.
Date 195_ Permit No.
o ry C.. CUPERTINO Fee $ /
Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
Al and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto:
u ,
Use of Premises
Owner
By ,` _ "$511�
Address
CON �,yPhone Approvedj'/ O�soG��* ��
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Ga-s Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
"Floor Furnace
Miscellaneous
(NAME TYPE
Appliance_Fees —��—�—
Inspected and Approved ....__._... ....
_ DATE. INSPECTOR
_ HOUSE GAS PIPING
Number of Outlets Size Mn
'Gas Piping Fees
Tested and,Approved
9TE INSPECTOR