1075 Ir
�f �TRpgT LOT NO.
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APjLI TION FOR GAS PERMIT
tbtJ CITY OF CUPERTINO
•'195_ Permit No.
j _ Fee $
t
r 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
"7of'Cupertiho, and all other laws applicable thereto.
Use of Premises-n,•II- FAMILY RESIDENCE
Owner ��"t"� _ Address,
ByjQF AAAARAL PING `'Address
Phone :3ANT�A C ARA, CALIFORNIA LIIFFORNIA I Approved^
!' I PLUMBING INSPECTOR
Remarks (Check ✓)
Type'of Appliance Units Fees New j Replace Relocate
Gas Ranges
vWall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
WarmingOvens
Percolators
Griddles
Steam Tables.
Gravity Furnaces �� •-�['`;fa.
Suspo ded Unit
Floor:Furnace
Miscellaneous
NAME TYPE)
pp lance Fees {
inspecteO and Approved -----.........:... ...............................................
.
.j DATE INSPECTOR
HOUSE GAS PIPING
NumbeS,of Outlets Size of Main _ f/
Gas Piping FFee _
Tested and Approved ./. /� _�... .. .._......:'................... ....
HATE INSPECTOR
GAS SERVICE •N' T E ss '.`;OFFICE
f a ^ COPY
L' BUILDING INSPECTOR'S 50+ ICE
CITY OF CUPERTIN
-'
To
You are hereby aut d connect-the ervice for ,� "
p
Owner or Tenant .... .. .........................
At ...
9/-- .. .. . ..........:....� �- -. - ......-_... .... .....
New Service -----...✓----: .....
No. of Meters ---- -------- ---^`" Reconnect .....-:----------------------.
- "•�,, Move Service .----------------....--
No. of Add. Meters .............. -^O. 'BING
Move.MeterINSPECTOR "•.
110 1/60-500 `--
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