1072 LOT NO.
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` AUG 12.��&PP� TION FOR GAS PERMIT
CITY OF CUPERTINO
CITY MOWN 195_ Permit No.
Fee $��
Application is hereby made to the City of Cupertino fora 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 imaccorcordance with the provisions of the Plumbing Code of the City
, d
Of Cupertino,-and•all:other-laws applicable thereto.
Use of PremiJf`"`F`AIILY RESIDENCE
ses'`"
.N .Owner Address_ r`-
-. gy r. ^ ' L PLUMBING, Address `
3940RaoR}41C2f �/
s, Phone r •A' CLARA, CALIFORNIA Approved i!
•'3 _ '• _ _ .. . � / PLUMBING INSPECTOR '
Remarks (Check' ✓)
Typed Appliance I Units Fees INew Replace Relocate
Gas_Ranges-
Wall Heaters -
GasvPlates II
Circulating Heaters
Blower Furnaces II
, Gas Fiied Boileis,
Warming Ovens I - II I I
Percolators
Griddles
Steam Tables I I ' II
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous i � i
NAME TYPC•) I `
II
I I
I I II I I
pp iance Fees
Inspected and Approved -----.........:... ....._......_.. ................ ...........
.
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Wiping Fees ¢j
e
Tested and Approved . ... . .. . :---
DA E INSPECTOR
�O
GAS SERVISE • . AICE a' OFFICE
b ICE
BUILDING INSPECTOR•A'6\410E - ;:J y'
CITY OF CUPERTINOIr
To
You are hereby autho •z t connect the GA s ice for
d
Owner of Tenant .--- ---. ..........
At... ..1.�. ...- - f �.
....... ......
New Service
No. of.Meters ...... ..:.. - Reconnect ............... '...... .. . '.
.. ,. '.
No. of Add:Meters ..............
trMove Meter --------------------------
.. . .1
+_'• _,:; �•
LU&BING .INSPECTOR
. 110 1/60.500.'. 'e'•?,j,'k ..,r. ,