1546\I
vo' I o
NO. At
ICtplt GAS
ff'-'� �PERTINO
LOT NO. 9'
PERMIT
DateCITY CF CUIjkH fi5" Permit No. -/�(O/
Fee $ Ck9
Application is hereby made to the City of Cupertino for a 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.
Use of Premises
Owne a
By
04 CONACt00., A
GB
Phone FiP'///�
Address_�,•oi_
Address
Approve
PLUMBING INSPECTOR
Type of Appliance I Units Fees II
Remarks (Check ✓)
New Replace I Relocate
Gas Ranges
Wall Heaters
Ga.4 Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
��
Gravity Furnaces
Suspended Unit
Floor Furnace
11
Miscellaneous
(NAMC TYPO
ppnnce Fees
II
Inspected and Approved .............. :.......
............... ............................
HOUSE GAS PIPING
Number of Outlets a Size of Main 3�—
Gas Piping Fees ,
�J_.�
Tested and Approved '.-nATE....A ....K*NS"1'2'CTmt
.....................
MTa