970 LOT NO.
H .... t,_�•- STREET '
TIMAY 16 ���A ,PLIdATION FOR GAS PERMIT Cr Y—OF-•CUPERTINO
C�1 ti
vr P.1 IP r• , 19y��':' Permit No. q70 •`�•-
I .
Fee S-
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.
N
C
Use of Premises
in Owner
'By Joe Amaral Plumhi Address 90.E
CONTRACTOR, AGENT
G ` Approve
Phone PLUMBING INSPECTOR
v
Remarks (Check d)
^ .Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas lwt'!s
Circulatiq Heaters
Blowef.Fuinices
Gas Fired Boilers
Warming Ovens I I
Percolators I.
Griddles i � �-
Steam Tables'
Gravity Furnaces
Suspended Unit
Floor. Furnace - ��---
I , k II
Miscellaneous
NAME TYPE)
pp lance Fees I� I
Inspected and Approved ------ -------:...
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
,Gas Piping Fees
Tested and Approved
f SATE INSPECTOR