1073 (2) ' .. 1iL•WL- LOTNO.
pU 1 "�3b0
APPLICATION FOR GAS PERMIT
` CUPERTIN OF CUPERTINO
at
195—- 195_ Permit No... �
Fee $
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/pc 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 ( errs LLY RLSIDLNCE
M.1 A f
ha Owner: Address ���-ri��i/7��.•�
BOE AMARAL PLUMBING, I Address
�T Phone SANTA CLARA, CALIFORNIA Approved
I -
61PLUMBING INSPECTOR
Remarks (Check ✓)
Type of Appliance I Units Fees II New I Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers I
Warming Ovens
Percolators
Griddles
Griddles
Steam Tables ,
Gravity Furnaces I i I
Suspended Unit I I
Floor Furnace
I II
Miscellaneous
NAME TYPE)
I I II I I
I I I
p�Fees I II
Inspected and Approved ..............:..-!. ............................. ................
DATE INSPECTOR
HOUSE GAS PIPING.
Number of Outlets I I Size of MainJaZ
Gas Piping Fe�-, lTested and Ap . .... . ...........
DATE INSPECTOR
GAS SE-RVIC- ' TILE ,
PP `OFFICE
BUILDI G. INSPE d F F I CiP
CITY OCURTFNA
� I
A
........................ _ Q...----------.:. .....:.... 196.4).
To
You are hercbD;yautho Idl to conned the rvice for
'o a hereby
Owner>or Tenant - - ------------ ---- .... ..... ........... .......
At..... .. . ....... ... .. ........... . ... .. ......... .. .........
New Service
-----------
No. of Meters ..... ............... Reconnect ....
...............•:�.........
Move Service ..........:i!......
No. of Add. Meters ............. Move Meter ------------- --------
.............. -----------
4� L ING &S�i4�iO�
110 1/60.5 00