899 LOT NO. �_
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
G
Datef,
5_ Permit No.
JAN 201960 J Fes $ J so
Application is h ' b made to th City:of Cupertino for a permit to install gas pipes
and/of` yrp nceshsbe��i� eyerse s de hereof, and agrees to install said pipes
and/or ap iancs_in accordance with the provisions of the Plumbing-Code of.the City
of Cupertino, and all other laws applicable thereto.
u
Y Use of Premises
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cA Owner t. Address
By Address
ONTRACTOR, AGE. '-
Phone
- - ApprovedWILSAM D. BENEVICH
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace Relocate
Gas Ranges I
Wall Heaters
Gas—PI aies II I L;
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators I Q I 1
Griddles I I II
Steam Tables
Gravity Furnaces II I
Suspended Unit I I II
Floor Furnace II 1 "`�—•—
I I II I
Miscellaneous
I I it —��
NAME TYPE) I I
I I II I I
I I II I I
IL--T 1 "
I I II I I
h
pp lance Fees ;
Inspected and Approved ..............:...I.....................................
DATE .INSPECTOR.-. ,
HOUSE GAS PIPING
Number of Outlets I J�j Size.of .ajn . .
Gasping Fees
Tested and Approved ... . ... -'�' R Y q'
. ........;
DA E ���� INSPECTOR
a