1079 (2) LOT NO.
Nq; STREET
APPLICATION FOR GAS PERMIT
CITY OF CUPERTINO
AUG 9 196'iTIN0-
'•
Dat e 195_ Permit No.
Fee $ �
Application is hereby made to the City of Cupertino fora permit to install gas pipes
ancim 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 other laws applicable thereto.
Use of Premises I -FAMILY RESIDENCE
u
in Owner -AAddress
By iu, AMARAL PLUMBING, Address
,. c�vrnaaiaoitL.pd4F.9A •
k I- Approved /-
Thone SANTA CLARA;M-CALIFORNIA,
PLUMBING INSPECTOR
Remarks (Check ✓').
Type,of Appliance . (Units Fees.,ll New' I Replace I Relocate
Gas Ranges. II
_\r/all Heaters
Gas Plates I I -4L .4, I I
Circulating Heaters •"
Blower Furnaces ',,,I "•3;
Gas Fired Boilers I -'
Warming Ovens
Percolators-k/-�, I II I
Griddles 1 1 I II
Steam Tables
Gravity Furnaces I I I I
Suspended Unit I
Floor Furnace I I
II
Miscellaneous
NAME TYPE)
I I II I I
I I II I I
_ I I II I I
pp lance Fees
Inspected and Approved ..............:... ................................................
DATE INSPECTOR
HOUSE GAS PIPING
Number oM ....
I Size of Main
Gas Pipins
Tested and . .--. .._..... ..................
q TE INSPECTOR
GAS SERVICE NOT } 1 s ' OFFlcfi
sel 3 BUILDING INSPECTOR'S: �C PY
, ' a
���
CITY OF CUPERTIN 4
�f .J f
.. � ................... 196-
.•./. �....�' .S.
-To _
.. You are hereby autho ' t onnect the ervice'for -'�V
Owner or Tenant .... . �(1..`.....��...o... ......... ✓ CEJ
At_.f.C.l.P.1. 4. .I:.........
_........ . .. .................... ........................ .:.�::
New Service No. of Meters ......r---------------- Reconnect ...........:........'::::..:. - r
Move Service !��f "
No. of Add. Meters .............. Move Meter "`'4'^
t PLUMBINGvIN_ SPE.CTOR *'
'110 1/60-500