1313 �095`Y• ,D,�pPrR TRt't' LA.v,r- � ( �
LOT NO.
� NO. 'tl�r /�rr�
fi D FOR GAS PERMIT
�APR 17 ���CI � F CUPERTINO
Date Permit No. n � � _
,� =C1TY OF CU �� Fee $ �X� .',:
� . , �..
� ,, � App(itation is hereby.made to the City of Cupertino for a permit to instalLgas'pipes �
� ry and/or gas appliances as listed on;the reverse side hereof, and agrees to install said'pipes �;:
qand/or appliances in accordance with the provisions of the Plumbing Code of the-City
�} of Cupertino, and all other laws applicable thereto.
(t c I � 1
�' _ .� Use of Premises__t�CS/OL"MGC . � �
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' /vi Owner /nitMnN►��itfN R�,ORC. Address • ^
F-�- � ^ / w�. �:
By �!/RD� P<vA2/7/N�' Address j
CONT0.AG'IOR, AGENT ` I ��„�� ,�
�`�' I Phone�.P- �- �/// - _ Approvp 'J :
' - . PLUMflING INSPBCT 0.
i +
S.. �
, ��
Remarks (Check ✓)��
Type of Appliance I Units Fees II New � Replace �'Relocate
' Gas=Ranges I � �� � ' � '
\�(/all Heaters " � � �� � •`�.
Gas Plates �I - � I� � .� ,'r � . .c
Circulating Heaters I I �I � • �.�- �.�t
Blowet Fumates � � .�� �� � -� `
Gas Fired Boi!ers � � �� � � " ',:t� '
Warming Ovens � ,' � �� ' � �� •�
�Percolators -" � ' � � � 3. ..� �:-
Griddles � � � �� � .' `� U ��
Steam Tables � � ''- � �� � � " �
Gravity Furnaces � � � ��_ � ;. � �
Suspended Unit ' � � II � �� � '
Floor Fumace �. � �� . '� �_��
� �'�" � � �� ' �
Miscellaneo¢s . � � iI-. -. ; � i
�NAME TYPG� I I II � I I
'� � � I� � .. �
� � � I� - � � I �r~
I : - I I I I ' I h f—
� : `� �� � ./�'VY
� I ' I II I .n' '"I� �
ppiance Fees � �% DOII I CI"s '
. 1,,•^_/"°i^........
Inspected and Approved'..--.._.....:._I�..............._--.....,:5�......
DATF. .INSPECTOR• w �-
HOUSE GAS PIPING . y ._
Number of Outlets � 'vL � Size of Main � �
� Ga�Piping Fees � � , o p� .
t,,
Tested and Approved . ...r...!�/.r...X_..�... .. . . .,..._..._:.._6..........
� DATE INSPECTOR 5
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