404 (2) r f \
LOT NO. 9
NO. STREET
9155 APPLICATIO�1 R GAS PERMIT
CPI1 OF CUPERTINO
Date Permit No. (lam
+�
TAIR
71 Fee $ Z, o
Application is here by madE'Yo t -ity of Cupertino for a permit to install gas pipes
and/or ga�• ggppli ces as listed on the reverse side hereof, and agrees to install said pipes
and/or 4-1 nc t aQa a¢�1 e provisions of the Plumbing Code of the City
of Cupertino, and all other a RTAle thereto.
Use of Premises
r7 Owne&&" Address
By— t� Address L�
• � '-'"CONTR°ACTOR=AGENT``. p
Phone Faux L, \ Approved
bonnyvn;o,j Ca;lp. ,V PLUMBING INSPECTOR ��,
Remarks (Check ✓)
• Type of Appliance Units Fees I New Replace I,Relocate
.Gas Ranges I I I
'� Wall Heaters
Gas Plates
Circulating Heaters 1 I II I 1
Blower Furnaces
Gas Fired Boilers
Warming Ovens I II I
Percolators
Griddles I I I
Steam—jablesl 1 II I
Gravity Furnaces II
Suspended Unit
Floor Furnace
I I III I
Miscellaneous it
(NAME TYPE)`
I I II I I
I I II I
I I II I I
I I II h_
pp lance Fees
Inspected and Approved ..............:...!..
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets 1 �Z, I Size of Main
Gas Piping Fees I S
— — —
Tested and Approved ... . a. . .�...L.: . .. ..........._...
DATE - 'INSPECTOR