1946 l D d LOT NO.
NO. STREET
® a PON FOR GAS PERMIT
C OF CUPERTINO
I -
Date r'o""�"' 195_ Permit No. 00019l
Application is hereby made to the City of Cupertino fora permit to install gas pipes
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
B Use of Premises
7 Owner pp,' Address
Address
" 'CONrRAcT , AGENT
Phone Approved
PLUMBING INSPECTOR
h I}Vv y
Remarks, (.Check ✓)
Type of Appliance I Units •Fees New 'I'ReplacD.,:Relocate
Gas,Ranges I I II I• •,ti.. { —'—
Wall Heaters " ' r
_
Gas-Plates I I r~ ' ,{• "S' I'
Circulating Heaters
Blower Furnaces
Gas Fired Boilers '• "
Warming Ovens I '�* . •y,
Percolators { t o . Iti•
Griddles I I •"Lb, 6
Steam Tables 'I '„-.i{ I y ..I {•.'sem-,
Gravity Furnaces
Suspended Unit I• - 1
Floor Furnace I,
Miscellaneous I it
NAME TYPE
I� I I • �: I' •' .•
pp;ante Fees
r
Ipetted and App'ro,v/ed-�......./....,•.�;.vjl�.:e...................:.....'......._:.......
pM7 Cfl�.--- - ATINSPECTOR* '
HOUSE AS PIPING ,
Number of Outlets I Size of•Main
Gas Piping Fees
` -
Tested and Approved�/:d�:.-r�.......1.. ............. .
DATA N INSPECTOR..
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a K G1 N
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