320 a
t _
LOT NO:
NO. STREET - '
APPLICATION FOR GAS PERMIT, ,
jjI OF CUPERTINO
p Date 1 Permit No._ CJ___ i
`O ���.:
Fee S
QAQ1�t-��Ay��oV��e��� �},y��77rr ity of Cupertino for a permit to install gas pipe's
and/or�aS�pplMAces'eSYStTIRBkEverse 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
LOJQERble t ffgo,CE
v
BETTER CUPERTINO HOME5
Use of Premises .�r c I B�.-�••�• -•
.rte, :k
..°l. SAN CARLOS SHEET Ioi ETAL WKS.
ti Owner 729 nLO COUNTY RD.AA ejSCARLOS
By Address
CONTRACTOR, AGENT
PhoneApprove_? d _
PL�iM a1NG INSPECTORy��
t Remarks (Check JI
Type of Appliance I Units Fees II ,New Replace Relocate
,!�as Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
-Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit •II ' '
Floor Furnace -
_
Miscellaneous
NAME TYPE
Appliance tees F �-
Inspected and Approved ..L9..7 : . .. ......_�'1.f/.. ..Gcft.�.....,
DATE INSPECTOR
HOUSE GAS'PIPING '
Number of Outlets Size of Main
Gas Piping Fees -
; sted and Approved ............:.:......... ............................ . ............
DATE INSPECTOR