1547 r O
IO�.7 O -, COT NO. �O
NO. s
EPIP. GAS PERMIT
6 IDG ERTINO
Date IJV`1 5 Permit No.
CITY OF CUPS IND
s� Fee $_
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
M and/or appliances in accordance with the provisions of the Plumbing Code of the City
cJ of Cupertino, and all other laws applicable thereto.
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Use of Premises Z&4t�o —
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Address
i e i
By Address
CONTRACTOR, AGENT
Phone, F P- se- Q/// APProve
PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces I I II I I
Gas Fired Boilers
Warming Ovens
Percolators 1 1 11 I 1
Griddles 1 ��
Stea�•Tables
Gravity Furnaces I I II_
Suspended Unit 1 I II —�
Floor Furnace 1 1 11
I II I
Miscellaneous � I '
NAME TYPE
I I II IT_
pp Iance Fees 1 I I I �
Inspected and Approved ..............:... .........................................
.......
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets 1 1 Size of Mai —
Gas Piping Fees 6�
Pum
and Approved . . �.. -
DA t INSPECTOR