1941 I oa
LOT NO.
NO. STREET '
L! TION FOR GAS PERMIT
CUPERTINO
A
Dates
A. ���
Permit No.
Fee
CITY. 4444 e l
Application '*hei: .� e City of.Cupertino For a permit to install gas pipes
and/or gas appligi%s'(zs•hsred on the reverse-side hereof- and agrees to'install said pipes
and/or appliancii,.ii',accoidance with the provisions of the Plumbing Code of the City
of Cupertino, aa14;otfiW-laws applicable thereto. j
u
� Use of Premises � ,-•_ ��- � _
rn Owner .. Address .3"':U �•AeQ,t. �..6!
By - - Address
nn CONTRA R, AGENT
Phone i;. _ Approve ?
UMHING INSPECTOR
� 4
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace I Relocate
Gas Ranges I I I
IX/all Heaters I I I
Gas Plates I III
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Oven ats'
Percolators. )t g1xa
Griddles`
Steam Tables. I II
Gravity Fdrdaces I I I I
Suspended Unit I I
Floor Furnace I I I I
I I II I
Miscellaneous I it
(NAME TYPE) I I II
I I II I I
G_ s_�
�
e e r laColl
pplance FeesInspected and Approved ..............._.I................................,. .. .......
DATE INSPECTOR,
HOUSE GAS PIPING
Number Size of Main
Gas Piping Fees
Tested and Approved ...... .#.J.(o.✓.... L
ATE t PE OR
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