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^Ct OF CUPERTINO
D C1T . FCU ' 1I\�195— Permit No.
M Fees
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.
y
:4
Use of Premises
A Owner W im"^-'-' Address
By
Address r
-.2.c fONTRACTOR, AGENT
' Phone 'L _ Approv
-- PLUMBING INSP OR
Remarks (Check ✓)
Type of Appliance Units Fees.11 New IReplace Relocate
Gas RangesI
Wall Heaters I I
Gas•Plates I I I I I
Circulating Heaters II I
Blower Furnaces �lil�
Gas Fired Boiler I I I
Warming Ovens
Percolators.
Griddles I I II I I
Steam Tables 1
Gravity Furnaces
spended
SuUnit II I I• •_
Floor Furnace I II
II I II I
Miscellaneous ) I I
NAME TYPO -�-_
11 III I
I k Ji
I i II I I
pp lance Fees —
Inspected and Approved .......... ...: ..I................................................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Size Of Main
Gas�Pip;ng Fees
T .� . . ..U7�...1..... .............................
ted and Approved
ATR INSPECTOR
GAS SERVICENOTICE OFFICE
COPY
BUILDING INSPECTOR'S or"ma.
CITY OF CUPFRTINNO
................................ 196.1
.......... ......
To I
You are hereby authorized to conne Ile GAS Service for
Owner or Tenant -dam
0 ...............................
At ----A .7.. ... . . ... ...... . .....................................................
New Service ..........................
No. of Meters .....�............... Reconnect ..............................
Move Service ........................
No. of Add. Meters .............. Move Meter ..........................
I!
............. ....................7
PLUMBING INSPECTOR
ito 1/60-500