1892 LOT NO. /
NO. STREET
A N FOR GAS PERMIT
® OF CUPERTINO
�JUL 2 71962 ':
Date ;?Zr 19!0�— Permit No. -2—
CITY
CITY OF CUPERTINO Fee
l� 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
l� and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
a,
u
Use of Premises—Z
N Owner Address
Address
CONTRACTOR, AGENT
Phone PW7 <-"77 Approve
PLUMBING INSPEC .
Remarks (Check d)
Type of Appliance Units Fees I -New Replace. Relocate
Gas,Ranges
Wall Heaters
-Gas-PlatesI Ii1
Circulating Heaters I 1 II 0 I I
Blower Furnaces ' I I I 1
Gas Fired Boilers
Warming Ovens I I II I 1
-Percolators 1-1 11 I I
Griddles I 1 II
Steam Tables 1-1 I I I
Gravity Furnaces II
Suspended Unit _ I I I I
Floor Furnace I I I
Miscellaneous i
NAME TYPE)
I I III I II _
I .i II I I
Appliance Fees
Inspected and Approved --:'...............!. .
_............................ .......
. DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I I Size of Main 3
Gas Piping Fees
— '— —
Tested and Approved .. .. .. ..lr.... . . ... . ....... .. . . .................
DATE INSPEC. . . .TOR