1062 yI r QTV�J', -' i siW Z LOT NO
STREET ��.�• i i ,o K
APPLICATION FOVGAS PERMIT b-I) i
F,, ryttk �wprr CITY OF CUPERTINO 0 IraTIM0 ,
I9i Permit No.
!is.!hereb
nde,to'the.city
Fee Itlgat of Cupertino Fora permit to install gas pipes '
.-3arid/or,gas•appliances as listed'on the:reverse,side hereof. and agrees to install said piper
'and/or appliances,Inaccordance with,the provisionsof,the Plumbing Code of the City
of Cupertino, ar d all'Sotlier`laws{r]]ap[plicable theretoEd�: .
Use of Premises
J c .- _ ..�
Owner A // ShC s Address/e.9_ 3
By ��ii•ni�ii- :z•:' _. �:•. ise'• Address cTJ?�
.� CONTHACTO ' AGENT
'~• Phone /�(.=..a f� Approved
PLUMBING INSPECTOR
Remarks (Check d) .
TYpS of Appliance,;I Units Fees'] Nea ReplaceRelocate
' Gas Ranges
Wall Heaters ".y
Gas—Hates
Circulating Heaters :�' ~ " I. , .� ,=`i:• a
Blower Furnaces - - II '' '' ._• •I w`''.: '
-Cys Fired Boilers
rming Ovens •, ;'l' t.,:-°'•t-:: ;' +
Pefcolators
Griddles .. • I I - -11'?� }:Iyc-`'.-Cs=1 '
Sim Tables I I,r .ga• } 'a�T:
Gravity Furnaces . " _I� : ��� .I", • = I.
—Suspended-Unit 'l •-� � � ' "�
Floor Furnace I II .91
Miscellaneous
NAME TYPE) I ---------------,
I I II.• I I '
I I I I I
I I II I I
pp lanceFees - I II P
Inspected and Approved ..............: .:I...................._....................
DATE, •INSPECTOR
s? ' HOUSE GAS'PIPING
Number of Ou[IN etsI �I . Size 'Of Main
Gas�PiRing Fees
Tested and Approved .. .. . .�/ld4l..:. . ........................
DATE INSPECTOR
�V l
GAS SERVICE NOTICOFFICE.
6CQPY
BUILDING INSPECTOR'S -EI ;y
CCCY OF- CUPERTIN "
19G.Q
TO
You are hereby authorized to conned the GAS service for .
r
Owner or Tenant .... ( --------
........... ......... . ............. -_.........
...
'New. Service -....,. .
-
No. of Meters // '` `'
....L.................. 1 i, ..,.;a:>:Reconnect..'i
.....:............. . .....
r
Move Servicn
e..: L:.-.....-- .
�. . hra . .:.
No. of Add. Meters ------.------- •�� -•.Move,_Meter -............
_Y
• • -. .... . . .............ice ...........
P BING INSPECTOR
1101/60-500 .•`t-1'1