1889 LOT NO.
NO. � •
® T dN FOR GAS PERMIT
JUL 2 7 196ft CUPERTINO
Date 7— " 7 (1 196 Z Permit No. /�U
CITY OF CUPERTINO Fee $
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 laws applicable thereto.
/ ��---�-
Use of Premises s
Cn Owner ��'•s–gr.'o-..2 Address_/•� `�
I.
By Address/v , Q �_t
CONTRACTOR, AGENT
Phone U&';' 3 17 Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall, Heaters
Gas Plates �� ° 4 .� . ✓Lo
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens �� 1
Percolators �, Q
—Gr—iddlesj I
Steam Tables
Gravity Furnaces _ �I
Suspended Unit. I
Floor Furnace
Miscellaneous � � i�� � i
NAME TYPE)
III
pp lance Fees
Inspected and Approved ........ ... ... ........... ................................
.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I Sizeof MainGas
P g cl L
;Esteed Approv
land ed .. f ..
ATE INSPECTOR