1437 O J I / ✓s- LOT N0- 4(i�----�
NCE
SEP�6 r,�r R MOGAS PERMIT
Date nitV A[ /41DCQPermit No tf—'3
Fee i
n 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 Premi �/QEi✓C E
iv Owner P n E [7N Ad >oSE
ByP&AD /
rAGEN-1 Address C'CONTSACM
�o
"-77111 APP
PLUMBING WSPa
Remarks (Check ✓) .
Type of Appliance I Units Fees I New Replace Relocate
Gas Ranges � �
_Wall Heaters �
Gas PIS
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Gri dles
Steam Tab es
Gravity Furnaces 1 11
rSuspm ed Unit 11
Floor Furnace 11i
Miscellaneous j
(NAME TYPE
PP IanceFe—es .A
Inspected and Approved .................. ................................................
DATE INSPECTOR
' HOUSE GAS PIPING
Number of Outlets ,? Size of Main
Gaa Piping Fees a?.0 �
-te-- �3
Tested and Approved .. ...?.�e �. .. ..... ... . .......................
DATE INSPECTOR