318 LOT NO. 106
< �
/ NO. STREET.;
2155 APPLICATION FOR GAS PERMIT
VIR�km
MCI)
UPERTINO
Date , Permit No.
lu Z <—o
Fee $_ `�
Ape�c�tyn OFiere r}},,g��'rtG'ty of Cupertino fora permit to install gas pipes
and/or gas appliances a�Nk@§berse 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 applicable thereto.
H BLOWER FURNACE
u BETTER CUF'ERTINO HDIH
. Use of PremisesL �
" SAN CARLOS SHEET METAL WKS.
IM Owner779 06D 09UI.ITvRo6ddt 5+l r^erzi nG
By Address
CONTRACTOR, AGENT
Phone Approved
PL MBING INSPECTOR Sy„�
,f Type of Appliance I Units Fees Remarks (Check ✓)
I New Replace Relocate
Gas Ranges I I
Wall Heaters II
Gas Plates I I II
Circulating Heaters
Blower Furnaces I ) I II
Gas Fired Boilers
Warming Ovens
Percolators I Q
Griddles II
Steam Tables I II
Gravity Furnaces
Suspended Unit II
Floor Furnace
II'
Miscellaneous I I
(NAME�TYPE)
I I II I I
Appliance Fees — I�
Inspected and Approved ....... �16.
"'
A F. ..INSPF.CTO0.
HOUSE GAS PIPING"
Number of Outlets I �I Size�Of Main
Gas Piping Fees I I'
Tested and Approved ............ .:r.. _...........................................
DATE INSPECTOR