1343 .2O 7' I toePAI-W TiPEE LOT NO. S.
• • •.
NO. SnEET
� N FOR GAS PEKMIT-•
D
OF CUPERTINO
JUN 16 19M (
Date '195_ Permit No.
CITY OFA CIiRERTINO Fee $
- Application Is herbymade to the City of Cupertino for a permit to install gas pipes
- h - .
and/o�gas appliances_as listed on the reverse side hereof, and agrees to install said pipes
n..ces;'inlacordance with the provisions of the Plumbing Code of the City
V _ofiCupertino,-}and41146the laws applicable thereto.
Use ofPremises,,'&-s/O,6.1y "
v
OwnerCDAi�jvwricrN ALDRS. Address X/ E
s By PUiPD r t•i�L'/iDs9� yF Address ' L
"CONTRACTOR, AGENT
1L rte /cam=' = /// ' I Approved I^ I\l��X,
` PLUMBING INSPECTOR ��
Z.
r'*, ;Remarks (Check J)
Type of Appliance I Units Fees, Lpew,;.1 'Replace I Relocate
Gas Ranges
Wall Heaters.'
Gas Plates - : I,. Ir-. Sr•Ili,'<;�`;3:e•.. '. 5`� <
Circulating Heaters I:- • .I�gr'.�F.II:'` �t: :cl ^"f :.?I'�:�rz. j
Blower Furnaces I.am:I;R, `•'-tlti`:.;xx '•k�l � =w��`I'I'� '
Gas Fired Boilers *! '
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity. Furnaces )L7-,-IT: II
Suspended,Unit
Floor Furnace
Miscellaneous I I it I i
(NAME TYPE
I I II I I
I I II I I
drr i I II I I
pp lance Fees I a:0 o T—
Inspected.and Approved ............... L.....--_.............-......:........:-...
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I 2 I Size of Main I. 3
GPng Fees 12, o
-,Tested and Approved .. . ..-..a.bl...l.... ................:....:........
DATE INSPECTOR
�ij,