839 LOT NO. W
NO. STREET
4� FO PERMIT
IV.,95—
OF CUPERTINO -
fov2P 95911 9 95 Permit No.
CITY or CUPERTINO Fee$
QApplication 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.
aUse of Premises r r J
'6.
cb Owner) ^ ` `�" -Address
ry Y
C• '` By Address
HEATING)ISFa9HEPh MhEq*AT CO.
PhoR497 Sfav�ns Approved
PLUMBING INSPECTOR
�, Remarks (Check ✓) .
Type of Appliance I Units;;F,ees I New Replace Relocate
Gas Ranges I iid 11
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces -� / /:j'd �� ✓
Gas Fired Boilers
Warming Ovens
Percolators
Griddles + ��
Steam Tables f ��
Gravity Furnaces
Suspended Unit II
Floor Furnace
Niscellaneous
NAME TYPE) I II
I
Inspected and Approved .._.-------.:... ............._._.........................._.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
—3--
Tested and Approved .. . .....7�Z.�l.... .. .......................... ......
DATE SNSPECTO0.
' 1[ OFFICE
GAS S V E• NOTICE corn
- BUILDING INS EC�jOR,� OFFICE
CITY OF UI?RRTFNO
j ---------- ---- / f....... 196.
To
You are hereby authorized to connect the GAS service for
Owner or Tenant .... ..
j At..caO171...... . . .-.............--
!�
New Service ..........................
No. of Meters ---------------- ' ;:c Reconnect ----- .....-----...... .--.. -
-"' ' 4'-•-'' Move Service
r ;'v,
No, of Add. Meters ._:'.:i..:.{ Move Meter ..........................
............ .. - ----------------. ---
LU BING INSPECTOR
t10 1/60-500 : '� ��'`�