2140 (2) LOT NOy O
NO. STREET
.;
ff�;'J
CrInION FOR GAS-,rP:ERMIT
.OF CUPERTINO ?r
P.N�7 "1953 • I � , f _
Date 3 t94�+. r Permit No: �� '� " P
4:��'. .:_ "GiT�' ( F" l�PERT1Nf� ' . Fee
'I Application is hereby made to the City of Cupertino for-a+permit to install gas pipes' ,
1, and/or gas appliances'as listed;`orq the reverse side hereof and agrees to install said pipes
rand/or appliancerin accordance with-the provisions of the Plombing-Code of the City
of Cupeifino;and•all. er laws applicable thereto.
_
Use of Prem
Owner. Address
y _ '
y $ �-'^"? �, Address
TR -FF-• `C�
CONACTOR, A6iNT
l Phone .A/J'L� Approved
- I PLUMBING INSPECT
�i
Remarks (Check Ir)
Type of Appliance—I Units Fees II New I Replace I Relocate
Gas Ranges I I II
Wall Heaters
I II_ I Llt.y
Gas Plates I
Circulating Heaters I IL
Blower Furnates
Gas Fired Boilers
'.•Warming Ovens I I II I I
-Percolators I I I I
Griddles
Steam Tables I "lam' �I `,
Gravity Furnaces I jl I I
Suspended Unit I II I
Floor Furnace I I I
I II I
Miscellaneous I I i_ I
(NAME TYPE) I I II I
I I II I I �
II i II I I—�--
I
pp lance Fees I I�--��—
Inspected and Approved ..............:...!.
t .
DATE INSPECTOR
HOUSE GAS PIPING
-Number of Outlets I Q I Size of Main 17—J
•Gas Piping Fees
.
Tes — .?3.
tedd and Approved ... .......... :54
....... ....... . . ........... ........
DATE INSPECro0.
' t � O • O \ O S
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