660 (2) LOT NO. T
NO. STREET
i PA PLICA ION OR GAS PERMIT
,+ / CITY
JU • UPERTINO
z f� t
Date J U L 195 195 , Permit No.
' 0
.i'.0. y"i Ur GV RTINO .. Is
4 Fee
-
\ Application is hereby made to the City of Cupertino Fora permit to install gas pipes
and/or gas applia`ices as listed on the reverse side hereof, and agrees to install said pipes
�D and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
:a
Use of Premises c/ u
�n Owner��-rv-c"^�DIVAddress-
f
By tT 's'�� 1 0.
Address
)7497 Aevauct°ree�, ° e. Cale• Approved
Phone
- PLUMBING INSPECTOR
Remarks fCheck`J) .
'Type'of Appliance ,I Units Fees II New Replace Relocate
Gas.Ranges
Wall,Beaters
Gas Plates I I I�
Circulating Heaters
Blower Furnaces j1 /.So 11
Gas Fired Boilers 1 ••1I,
Warming Ovens L, I I A
Percolators
Griddles
Steam Tables
Gravity Furnaces /
Suspended Unit
Floor Furnace
Miscellaneous i
NAME TYPE) I II
II I
i pp lance Fees T T.So r
Inspected and Approved !I—. ......................._.............
DATE [/ INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main ..
Gas Piping Fees
Testedand Approved ._..... ........._.I...............................................
A. DATA INSPECTOR
r
GAS ,;SERVICE c NOTOFFICE
COPY
_ BUILDING INSPECTOR'S OEFIC.
CITY OF CUPERTINO
^.'., ---- ........ , 1 .
....................... ...0.. ...% --
a',r, To ;r
You are hereby auth rued to connect the GAS s nice for
Owner or Tenant` .. ...t:�./ V..C...`-".P�✓�:Q:[1:!':c!�n�
-.,- --------- ..................................................
New Service
No';of Meters ..... .............. Reconnect ..............................
Move Service --------------
No. of Add. Meters .............. Move Meter ..:...:.........:........
.... ........... -------------
------- .........:...
Y'= PLUMBING INSPECTOR v
110 6/597500