1278 1013 ( t�7 LOT NO.
NO.
l� �P"""*CITY
�tI '1 y�A FOR GAS PERMIT
�f EB 1 " *CCITYp►VOF CUPERTINO
Date &V- tt6 �uP°"' 19V-Z Permit No.1 7 -79
SA �� v°•
Fee$ '
Application is hereby made to the City of Cupertino fora peimii to install gas pipes
and/or gas appliances as listed on the reverse side hereof• and agrees to install said pipes.
6p and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
" a Use of P � �/ /7�
remises � //Y
+ in Owner / `?(� T4
�y Address
I. t - `�:,-":Phone •. - Approve===9
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PLUMBING INSPECTO
Remarks (CheckJ,)
Type of Appliance [Units Fees II New I Replace,l Relocate
Gas Ranges
Wall Herters
Gus Plate3 I II I a
CirculatingHeaters I I I .0,6 1*
Blower l urnaces
Gas Fired Boilers
Warming Ovens
Percolators AC
Griddles
Steam Tables
Gravity Furnaces I j�
Suspended Unit— jj 1 4
Floor Furnace- _
Miscellaneous
NAME TYPE)
I IIIA I
I I II I I
I I
Appliance Fees I
Inspected and Approved ..................I..............:...............................
r
pATF. INSPP.CTOR
HOUSE GAS PIPING
Numbet of Outlets 07I Size of Mam
Gas Pilling Fees , O
—�— /' _
Tested and Approved . ...... ...1.. '.................
DATE INSPECTOR
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