901 IV LOT NO.
V=..--4NB. STRBBT
® JSP, 2I AN FOR GAS PERMIT
CDiPer
OF CUPERTINO
JAN 201960 Date m No.
CITY pCPRTIf�O a Fees
` , \ A licatmn Is }iereb .made toith6.Ci gkC'u rfino`fot a permit to install s pipes
PP. y--- tyt _.. _Pe_... Pe said
P Pe
and/or gas appliagces as listed on thrreverse side hereof, and agrees to install said pipes
and/or appliancesyin?accordagcewith4the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
V /
Use of Premises
t vo
v
In Owner Address I
By '.0 pa /?
Address
O TRACTOR, AG T, ��' •^ �
Phone - Approved WILLIAM D.:BENEVICH
PLUMBING INSPECTOR
I
I Remarks (Check d) .
Type of Appliance I Units Fees I, New Replace Relocate
Gas Ranges
Wall)]eaters
Gas Plates
Circulating Heaters
Blower Furnaces III
Gas Fired Boilers ISI
Warming Ovens
Percolators
Griddles III
Steam Tables
Gravity Furnaces
Suspended Unit IIL:,. :r:,:;,•�;'K;(=�Ly"i mr-
Floot Furnace � � ��r- �',�=5d�'.�•�K
Miscellaneous � � i��, � '. •.a.
NAME TYPE) I I III,
� III ' in
i
pp Bance Fees — I '%'
Inspected and Approved .._....._...: L.
DATE `A
HOUSE GAS PIPING-------------------
t
'Number of Outlets Z Size of Main
Gas�Piping Fees i/ I` _'.
Tested and Approved
DATE INSPECTOK. +��`�