1548 //
NO. STREET
R GAS PERMIT
® nERTINO
1(:1C,.' s X962
Date 195_ Permit No.
a CIJPERTINO Pee$ og
CITY OF
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.
0
Use of Premises
v p
h Owner e 1 li7�r6an7q!Address `��/�o/ �� _
By o 4 Address
t CONTRACTOR AGENT
Phone Approved
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges I ji
Nall Heaters � � ��
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit II
Floor Furnace
Miscellaneous
NAME TYPE) LI
III
Appliance ees
Inspected and Approved .............. ... ...............................................
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets a Size of Main 1,3
Gas Piping Fees a, Q
Tested and Approved ... . c'1.�( 1.�..�... .. . !.,tet.
DA P. WSPSCfOR