309LOT NO.
NO. STREET
2155 ION FOR GAS PERMIT
® � TCUPERTINOj _
{� Date / Permit No. •,
�O (�IIT ��// ((��[[' ����pprrDD��''^^''[A� Fee$
App llYn IOlSere�W15da4blt (GY of Cupertino for a permit to install gas pipes.
p and/or gas -appliances as listed on the reverse 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.
c BLOWER FURNACE
Use Of Premises cp' r•IIPFRTINf7 HOME9
a ETT
v IDLEWILD TR iF275,3
in Owner 5AN CARLOS SH�ETAdtd essAL WKC3.
fCON"ACTOR,
OLD COUNT" QD.- SAN A
By Address
AGENT�Phone _ Approved PLUM NG INSPECTOR
Type of Appliance I Units Fees II
Remarks (Check ✓)
New Replace Relocate
,Gas Ranges I 1 11
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces�-
Gas Fired Boilers j � ��
Warming Ovens
Percolators.
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
NAME TYPE)
i pp I�Fees
�-
Inspected and Approved �% ...��-........
/. T--'-......................
DATE. / INSPECTOR
HOUSE GAS'PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ..:.................... .......... ....... ..... ........ ..........
......
'DATE INSPECTOR
GAS SERVICE NOTICE OFFICE .. t.
BUILDING INSPECTOR'S OFFICE
CITY OF cup6TINO
.............. ............... -7b - ........
You are hereby authorized to connect the GAS service for
Owner or Tenant --C
-- lje-Zlt, .......
.......................... .... ..............
2
................
At v ........
New Service .............................
No. of Meters -------- .............
N6. of Add. Meters ........
Reconnect ............................ .
Move Service ......................
Move Meter ........ : .................
110 6/59-500, 9PLUJBING INSPECTOR