788 (2) Oslo• 9O .ILOT NO.
„i.ji0.""v. STREET ,;l J
a i -
"® o P ON FO €G S PERMIT
t� OF C f ..xINO
PI
�_ Date C[ T ��(, 195_ Permit No. /
``I l i \Of •-tE7t1Y.° R'GANO Fee $
Application is+hereby made to the City of Cupertino fora 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 othei laws applicable thereto. '
v
v
a 'Use o`fPremises
_�_
v `
In .Owner ss
u By Address
j C A AGE
Phone Approved -LOAM D. 9ENEYlad
PLUMBING INSPECTOR
1
Remarks (Check ✓)
Type of Appliance—I Units Fees II New Replace Relocate ;
Gas)Ranges
Wall Reaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces I�
Suspended Unit II
Floor Furnace
I�
Miscellaneous
NAME TYPE
• � := III I�� I� I ._
pp lance Fees I I r--
Inspected and Approved ...... ------- ...........................................
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets 1Z Size of Main—
•Gas Piping Fees s
'Tested and Approved . " '
' DATE INSPECTOR