614 i LOT NOAEC
NO. a5• HflT
PT
' ION FOR GAS.,PERMITt�` 'f :L••
7 T
OF CUPERTINO—-- - I
Date
a Y pp
Application is herebymadelto•the City of Cupertino Fora permit to install gas pipes
and/or gas appliances as listed on the rrev`rseoide 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.
u
Use of Premises
u �C�
is
in Own acs
Address
CONTRALTO , AGENT
Phone Approv �if 1_&c
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees I NewReplaceRelocate
Gas Ranges
Wall Heaters
,Gas Plates
Circulating Heaters
Blower Furnaces f�
Gu. Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPr)
Appliance Fees I I
Inspected and Approved ............. ........................................
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main-�nGGY
Gas PipingLees � .�
—=--
Tested and roved .//. .... .�...._�.. _.. . . . ......................
DATE INSPECTOR