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610 l ttm 1101.NO. NO. STREET 'v •�{ )' •, APPL'ICATIO�W. AOR GAS PERMIT jEi� j �QCITYIJIOfCUPERTINO` Date t 195_ Permit No. Al 1 I.0 C 1 InIItI 6-0 • ' ' Fee $ Application is hereby made to the City 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 of Cupertino, and all other laws applicable thereto. aUse of Premises T in er Address__ CONTRA OR, !GEN "'-Phone— Approved PLUMBING INSPECTOR Remarks (Check J) - Type of Appliance I Units Fees II New I Replace Relocate Gas Ranges -Wall Heaters I I I n, Gas Plates Circulating Heaters ,I -Blower Furnaces Gas Fired Boilers 1 Warming Ovens Percolators. Griddles Steam Tables I II 1 ..�:7 Gavity-.Cornaces I I II 1 1 Suspended Unit .11` ��FF 'r Furnace Miscellaneous I I I NAME TYPE) I 1 11 1 I ' •'I��' I II I I pp lance 'Fees Inspected and Approved . ......... .............. ................................ . DATE. INSPECTOR HOUSE GAS PIPING Number of OutletsSize of Main I' G Past Pas 'gFe i _1 Approved Td and ./ . .. .. ........ ... .......... este ........................... r. SNSPECTOA nATE s. a \ f f J /// , � \\ \ / no 2 . F ©$ } P, c7 � � \] � g § ; ® e : © ? k \ E§ g ; z \ ; /\ \ � , ® ' � } // ' § ■ . . } ƒ - 2 / � \§ %) \ �, ° « ■ . < \ / ? 7 ; . � \ Remarks (Check J) r, Type of Appliance Units Fees I New Replace I Relocate u Gas Ranges I I I I I ,. Wall Heaters 1 P. Gas Plates . j Circulating Heaters ` Blower Furnaces Gas Fired Boilers Warming Ovens I I. Percolators . Griddles Stearn'.Tables — _fa „Furnaces I I I Su_s_pended Unit— '~Furnace I II` I •" Furnace 'Miscellaneous I I •,.. II NAME TYPE) I ••1.' II I • I I II .� I I Appliance Fees I/•J— Inspected and Approved DATE' ,� INSPECTOR HOUSE GAS PIPING , . ? Number of Outlets I I . Siie of Main ' Gas Piping Fees —e— — Tested and Approved . ...........z:'.......I .:....... ........ .......... ........ ........ DATEt y INSPECTOR !`1 GAS 'SE "V 'NOTICE f`- O FIC-E BUILDING-I OR'S OFFICE :'- ; CITY"OF , ERTINO ........................... 19 To }t You are ie"ieb'y autho"ied to conned the GAS service for " Yt'M M ..{ .- �,OwPerr„orf„Tenant:_ -. . ......................................... n At -pL�/. OGt/Ir... . ........ . ..... .. . ................ New Service . Met .. . r econnect +f ......... . ... Move Service ........................ No. of Add. Meters .............. Move Meter ....................:..... + { ................................ PLUMBING INSPECTOR 110 6/59-500