670 (2) LOT NO.S -
- NO. STREET j
&I- r"AWICATION FOR GAS PERIiA1T
CITY OF'CUPERTINO ^'r
Dated 195_ Permit No.
o m'TV �1 . rUPERTIMO Fee :—�-
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/oi 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-
in Owner O Address
oN
By iEATndr a SHEET METAL_E Address
1749) Sreve�¢�4@'dtR'I{dT.oP9a SE��ere. CaR. Approved
Phone
PLUMBING INSPECTOR
,V
Remarks (Check'J.)
Type of Appliance I Units Fees II New Replace I Relocate
(las Ranges
Wall Heaters
Gas Plates I I;
Circulating Heaters,1� _I ( II I 1
ower Furn
a4es!""
. Fired'>"Bbilers.
_Warming Ovens 1 .• 1' `»� `;; I'
Percolators I (,
Griddles
Steam Tables
Gravity Furnaces I I I II I
Suspended Unit
Floor Furnace I j I • : II I
I I II
Miscellaneous• 1 •I..• n I
NAME TYPE I II
I I II I I
I I II I I
-
' �� " I I II -11
II I I
pp Iance Fees ,. ' I .J 1 I I
Inspected and A0pr6ved�lo�l�9.. : _......_.....................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets I I Siie of Main 1
'^Gu Piping Fees 1 1'
Tested and Approved ........................1............._.................................
DATE fNSPECTOR
GAS; SEt VICE NOTIC s'' :i °oPv�.. -
BUILDI G SPEGTOR'S OtI'I E m 'w}
Cl P CUPER/I�n 1
.r rN ►
To 1
You are hereby autho ' ed to connect the GA service f®r
Owner or Tenant -.0
/D ,SAt ..- ._GQ.-- .
New Service ..........................
No. of,Meters ......1.............. Reconnect ...........:............
:::.�.
Move Service ........................
No. of Add. Meters .............. Move Meter -----:...................
s .
),...----....
.................
LUMBING INSPECTOR
1t0 6/59-500-' -'----