1945 2 LOT No
No. ` STREET
,10 /�RP�ICATION FOR GAS PERMIT
�q �J'�Nu �1 OF CUPERTINO p
Dat��j"e�/1J �I I� MAip' `, 195_ Permit No.
Fees
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_ o 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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n
Use of Premises
v
05 Owner CO Address
c r
-�-J _ Address
CONTRACT , AGENT
Phone Approved oma
' PLUMBING INSPECTOR '
Re at (Check k ✓)
Type of Appliance Units Fees .IIw wReplgjp I-Relocate
W
Gas Ranges
Will Heaters
Gas Plates
Circulating Heaters
Blower Furnacess�
Gas Fired Boilers I I : � I T! • '' I'
Warming Ovens I .I.' �.•�•+ I
Percolators
Griddles I I�
Steam Tables III I
Gravity Furnaces
T
Suspended Unit-
Floor
nit Floor Furnace
Miscellaneous I I
NAME TYPE)
pp more Fees
inspected and Approved ................ .I..................:...:. .'-....:............
DATR INSP / . R
HOUSE GAS PIPING
Number of Outlets I / I Size of Main —
Gas Piping Fees 117. J
—�---
Tested and Approved ...... ..?/ �.. ..1... . ................
DATA I!qP&:TOR
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