1371 -ANO. STREET -
® 6>�'"�� ION FOR GAS PERMIT
OF CUPER11NO
l AUG 4 1
Date 195_ Permit No. 171
� e0
N CITY OF CUPERTINO Fee $a-
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 lawslicable thereto.
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Use of Premises
Owned—lJtJ t tJSS', C%Address
l' Address
Q �/ CONTRACTORHAGE1__
O- / Phone c " '7 Approve
PLUMBING INSPECTO
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace I Relocate
Gas Ranges 11
Wall Heaters h
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces jF
Suspended Uni[ jI -
Floor Furnace
11
Miscellaneous'
i
(NAME TYPE I I �
III I�
pp lance ees�- -�--I
Inspected and Approved .............. ... ...._..........................................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fel
—�— --
Tested and Approvede..q ......................
IIA 8 INSPECTOR