1280 '/V U 93 I �/�/ /r �r/ X LOT NO. Z/
NO. STREET I
® 2a jaCT
N FOR GAS PERMIT
� OF CUPERTINO
�'' B 1969
Date 19zz Permit No.
CITY OF CUPERTINO Fee$ / d
\ Application is hereby made to the City of Cupertino fora permit to install gas pipes
�s and/or gas appliances as listed on the,reverBe 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.
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`
Use of Premises e �
:a •
V D CJ7I �Uz+�) r
• �n Owner
l v OwneV �
y^:ddress
By Address
Phoe App
--
PLUMBING
PLUMBING INSPE B -!
Remarks (Che W
Type of Appliance I Units Fees II New Replace I Relocale
Gas Ranges I II I I
Wall Heaters I I 1
Gas Plates 4
Cir' ating Heaters
Blower Furnaces • , I II I _
Gas,Fired Boilers I k l
warming Ovens
Percolators I t I
Griddles
Steam Tables
Gravity Furnaces
Suspe*— Unit
Floor Furnace I I I
II
Miscellaneous I I II I
NAME TYPE) I I •�
II I 1
I 1A*
este_
—�—
PPflance Fees
Inspected and Approved ..... I.................. ......
DAT�q;. - INSPHCTO0.
HOUSE GAS PIPING
Number of Outlets I I Size of Main I ! k*
— '—
Gas Piping Fees I �'
—
Tested and Approved . ��.... . " ,.,, . ., ._
DATA t- INSP9GT00.
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