851 LOT NO.
NO. STREET '
APPLICATION FOR GAS PERMIT
{H `� 41 -Y OF CUPERTINO
Date''1 "a` + 1 _ Permit No. �S /
�a W. v AV ID95
Fee$4-5w—__ .
CArpplicahon is hes�yErrgq ej�(j' e 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.Cupertirio, and all other laws applicable thereto.
' Use of Premises
Ii, Owner +�!.d.�u'c'x��-P-+�'*—Pte/,.-e-u< Address
ByDIVI Address
HEA-fifkT "c5TE1'r151 rAL CO, App
Phonerovedwn r TAM n avnl es Iru
OP . -n
PLUMBING INSPECTOR
Remarks (Check J)
�Type'of'Apgliance .•I Units Fees I New Replace I Relocate
Gas Ranges
XVAI Heaters
Gu Plates
Circulating Heaters
Blower Furnaces
Gu Fired Boilers
Warming Ovens
Percolators
Griddles
Steam'T.ables
Gravity.Furnaces _
Suspended Unit 1 1 II
Floor Furnace
' Miscellaneous
NAME TYPE
-Appliance Fees I Ti oil
Inspected and ApprovedlL. .. �'�.-------.--.
ATF. INSPECTOR
HOUSE GAS PIPING
Dumber of-Cutlets Size of Main
Gas Piping Fees ,
Testedand Approved ..................:..... ................4.............................
DATE INSPECTOR
SERVICE USTF-F.ICE E CWTICF.
♦. Cops-.
4+ BU ILQG INSPECTO '�
TY.OF CUPERT -
i
MMM
i Toy
You are hereby autho
rised to connect the GAS service for
.o-t- -/
--.t•�. Imo . (
" OwnBt.or.Tenant . _ ��.. . ¢C . �d�/�
At ^ ..
.... ...............................
New Service ..'�
No. of Meters ..... .............. Reconnect ......................:.......
Move Service ........................
No. of Add. Meters .............. Move Meter ..........................
I{ � PLUMBING INSPECTOR