904 (2) V1P^ T gld.Q, .L
r• LOT NO. �^+
STREET
APPLICATION FOR GAS PERMIT
(( C•ITY OF CUPERTINO
DatV, I_� .h�n 1nF� - 195_ Permit No.
\ CIAVlicon ifflerebyP de to the City of Cupertino for a pergas pipes
a permit to install
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 Cede of the City
of Cupertino, and all other laws applicable thereto. 1
Use of Premises
v
�n Owner Address
gyp Address
Nrancroa, nceN ?.
Phone Approved WILLIAM n RFNFWILLIAM r H
PLUMBING INSPECTOR
Remarks (Check d)
Type of Appliance I Units"Fees I New Replace Relocate
Gas'Ranges I II I
Wall Heaters I. I• - I I
Gas J(Utes
Circulating,Heaters I I II I I
Blower Furnaces I I
Gas Fired Boilers I I I
Warming Ovens II I
Percolators ( I I
Griddles
Steam—Tables—,
Gravity Furnaces!
3usended Unit
Floor Furnace
Miscellaneous I I iI
NAME TYPE)
I I II I I
I I II I I
I I II I I
I I II I I
I I
Appliance Fees I
Inspected and Approved ..._.........::. ................................................
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets I 7——ISize of Main —j —Y/,W�- --
Gas Piping Fees
,Te'xfed'ind Approved ... .I...... . ...................................
' � DATE INSPECTOR