603 I ISLOT No.j 4
I' O. STRfle r /1,�
APPLICATION F,O AS PERMIT
CITY OFCUPERTINO
Date - --- 1195_ Permit N&__fU j
t- Fee$�_��
AliRdon'is:herekylmade trith City of Cupertino for a permit to install gas pipes
L1 1 1 iad ti.isle
and/or gas apphances as fisted n tf<e verse 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_-
u
u
a Use of Premises r/ `
N OW� e _
Address �'
Pho a coNrancTol, nGarvrg [i �a2(/`�tZv Qs/
Approve
• ' j PLUMBING INSPECTOR
U
+ o' Remarks (Check ✓)
=Type Of Appliance )Units Fees II New ,I Replace I Relocate
Gas Ranges
,wall eaters
iGas Plates"
,CirEvlating Heaters ,I II I
Blower Furnaces
Gas Fired Boilers
Warming.Ovens I� I
Percolators
Griddles'
Steam Tables
Gravity Furnaces
Suspended Unit..,:,.,
Floor Furnace ;; _I I ,,.��_
Miscellaneous
NAME TY,PE)
II
pp_iancc Pees I1 11
Inspected and Approved ..............%_!----------------- ...... .... .. ......
DATE. - INSPECTOR
f� HOUSE GAS PIPING
Number of OutletsI Size of Main �. •.
1 ' Ga�Piping FFees
Tested and Appr�!o.. ........... .pTE // INSPECTOR