669 /CG y7 iC tea./t G��d 'Klgl . LOT NO. 3..
NO. SMBETT�
-'"AP,PLkATION FOR GAS PERMIT
/� 1 CITY OF 6PERTINO
J.
U 1215 211119'4 +959 '.
Date 195_ Permit No.
CITY OF CUKRTINO Fee s
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.
R .
v
Use ofPremises, -+-u-�-•� '
05 Owner - Address
DIVISI"r. � ftf
Address
By�+Ev"' sraans` wApprove
Phone PLUMBING INSPECTOR
Remarks (Check J)
Type of Appliance Units Fees II New I Replace Relocate
Gas Ranges
`Wall Heaters I �I
Gas.Pclates
Circulating Heaters
Blowe"r Furnaces / /,SO I� ✓ I
Gas FiredBoilers I ��
Warming Ovens I I �I � I
Percolators I Q I I
Griddte5*,�*
St2am�Tables'
Gravity Furnaces I�
Suspended Unit
Floor Furnace' / II
+Miscellaneous.
�INAME TYPE),- I �I
—
�
d
pp Ianee ees ATP IN
0 P Ian
d Approved /�.c�. . ...!. -
! s ede
SPECTOR
�ay'i. !IWOUSE GAS PIPING
YI
11"FNumbeP,:o Outlets I Size of.Main
fi :Gas Piping Fees
r, .,l—.y
,Tested and'Approved .......
........
_.......
I ...........................................
DATE INSPECTOR
GAS ;ERX, N �� }rE °opCE
UILDING INSPEC 11 OSCE
CITY OP CUPERTIro
�.� ....... .. 1
To
You are hereby author' ed to conned the GAS service for
Owner or Tenant ...............................
New
.... Servi'c..e........................ �
. t
No. of Meters .. - . ..... Reconnect ........
..-.
'
„1 Move Service .....` ..-......-
No. of Add. Meters .............. Move Meter ..........--.............
..............
._.........: ..............._.........'--........................-_....
1 PLUMBING INSPECTOR
110 (/59=500 !