1810/ e9l Z/ I (f✓a4t- 4 LOT
NO. STREET ,
® FOR GAS PERMIT
JUN 2D 962 F CUPERTINO
}1
Iva- Permit No. t U
ITY OF CUPERTINO o2
Fee $ 00
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
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
c
:a
Use of
v
n Owner
r
yn✓ Address
Addressa el
CONTRACTOR, AGENT
Z Approve
P.. MBING INSPE
Type of Appliance I Units Fees II
Remarks (Check ✓)
New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces�-
Gas Fired Boilers
Warming Ovens }– ��
Percolators
Griddles
Steam Tables
Gravity Furnaces
�St1�2ended Unit
Floor Furnace
Miscellaneous
(NAME TYPE
pp lance Fees—��—�—�—
Inspected and Approved ........
INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Testedand Approved.......................................................................
DATE INSPECTOR
GAS SERV4.CE -NOTICE
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
fZ-Yo
..................................... ...........
'To
You are hereby aut oriz to our
Owner or Tenant ...................(..1. ,..
'At .......... :.......r...�-y -�
No. of Meters ..-a ..............
No. of Add. Meters
1 110 7/61-500
service for
OFFICE
COPY
196....`
New Service
Reconnect .........................
Move Service ........................
Me Mr ......................
........ .............
PLUMBING INSPECTO