1074/ 2
.� LOT NO. Y
TIO.': .1 Sep
v .,
, G :�. 19BAPP DATION FOR GAS PERMIT
CITY OF CUPERTINO
• la^�- "� �`AU�J�ER��lO
4,.
" Date 195_ Permit No.
Fee $ aif�
Application is hereby,made to the City,.of'.Cupeitino for a permit to install gas pipes
n - , wS.: ,p: 1.
and/of gas appliancesas?listed on the, reSerse:vde 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. ,
i
Use of Premises —1`cHMI"LY=RESIDENCE
in' Owner 111 i Address 6 Ilei
.,n.
ByIOE"AMARAL PLUMBING,I Address _
38:0&7E' *kANdDA-
• •Pfione SAN_r CIARA, CALIFORNIA Approved -
1 PLUMBING INSPECTOR
l •�....
<, Typ of Appliance I Units Fees I
Remarks (Check ✓) .
New I Replace I Relocate
Gas1Ringes
;-Wall'-Heaters
_
-Gas Plates II
Ciicplating Heaters
. Blower Furnaces I A II
Gas Fired Boilers
Warming Ovens
,Percolators II_
Griddles ,'.
Steam Tables I •
I
Gravity Furnaces I I
II I
Suspended Unit_ I I
II
Floor Furnace
Miscellaneous
iI
(NAME TYPE)
I
i I
II I I
I I
II I I
I I
II I I —
I I
II I I
I I
II I I
Appliance Fees
Inspected and Approved ..............
...............................................
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
—�— —
Tested and Approved ......... �r> POI.........
MATE INSPECTOR
2e �>
To
You are hereby a
Owner or
At
GAS SERWC O.TICE. ` • OFFICE;= "
BUILDING INSPECTO S :OFFICE - +� COPY'
CITY OF CURL IN&
tho ized to connect the service for
- GGG
... ..--- -- ._... ....`..................
New Service ---
----------- :...-.:.....
No. of Meters I----------------- Reconnect ............:.:......:.
}r
Move Service ........................ } ,
i .
No. of Add. Meters .............. Move Meter:- ................
... ........... ..........�.:..::....................
PLUMBING INSPECTOR
110 1/60.500 '� °�