1185 ��1�j /��
1,_S-,-,J e UC.,2 S V�' iJ I� LOT NO
NO. STAEBT
� & L - TION FOR GAS PERMIT
pOF CUPERTINO
.(DEC 3 0 00
a e 195_ Permit No. I ��
In CITY OF CUPERTINO Fee ��
Application is hereby made to the City of Cupertino for a permit to install gas pipes
Vo 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.
:a
Use of Premises
.
Owner)(
m AddresX
By V Address 0 W49.z
pCONTAACTOA, AGE
Phone XI�A' c� ' /90 oo - Approve _
PLUMBING INSPECT
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranbes
Wall Heaters
Gas Plats
Circulating Hcaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous � � i�
NAME TYPE)
III
pp lance Fees
Inspected and Approved ..............:... ................................................
DATP. INSPECTOR
HOUSE GAS PIPING
Nu um er of—out lets Size of Main
Gas Pining Fees � _
Tested and Approved ., ...I...
AT
INSPECTOR