1648 Lor No.• •� ,
NO. Q e
A N FOR GAS PERMIT
VAPR 2 41962 OF CUPERTINO
Date Q/L 2 O 195-d;L Permit No.
CITY. UV CUPERTINO Fee $ o1oO
a
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
V of Cupertino, and all other laws applicable thereto.
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u
Use of Premises
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in Owner—C&, nTiA.n A/loPr 7/vs Address e, wi
By Address .CL
CONTRACTOR, AGENT
Phone 7 —k/// Approved
PLUMBING INSPE O
Remarks (Check J)
Type of Appliance J Units Fees II New Replace Relocate
Gas Ranges mBi
Wall Heaters Gas Plates
CirculatingHeaters ower Furnaces Gas Fired Boilers
Warming Ovens 1 11
Percolators
Griddles
Steam Tables
Gravity Furnaces
�$uspended L1nitt
Floor Furnace
Miscellaneous
(NAME TYPE)
T
pp Iance Fees I II I
Inspected and Approved ..............:... ...............................................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main 7
Gas Piping Fees
Tested and Approved .. .. . ...'........ .. ........................................
DATA INSPECT00.
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