1083 (2) I •� — LOT NO.
5 B T':
i
'AUG 12 196QP ATION FOR GAS PERMIT
( CITY OF CUPERTINO p
CITY LlPw6�PLWYMI�O 195_ Permit No. %Z9 —
Fee S �—
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 provisionsofthe Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
v .
a
Use of Premises i -FAMILY RESIDENCE
rn Owner_ Address
ByJOE AMARAL PLUMBING Address
. . 3(30NT6tdEi'OBAA '
Phone SANTA -CLARA,'CALIFORNIA Approved
PLUMBING INSPECTOR
2Remarks (Check d) '•
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall.Heaters
Gas Plates
CircWating..Heaters
Blower Furnaces I ��
Gas Fired Boilers „;•_��
Warming Ovens �� •. :�
Percolators
Griddles �� _ !l-•. '-
Steam Tables
Gra,zity Furnaces
Suspended Unit II
Floor Furnace
Miscellaneous it
NAME TYPE.)
Appliance Fees �� P
Inspected and Approved ............. . !�
................
DATE INSPECTOR .
HOUSE GAS PIPING
Nurnt,er of Outlets Size of Main
Gas Piping Fees
Tested and Approved /..:... . ..�0�!..�...... ........................ ..
D TE INSPECTOR
GAS SERVICE,gNOTICE 5 :.� . :� ;,:#rOPY
BUILDING .INSPECTOR'S/ OFFICE'•
' CITY OF CUPERTINO
i'. ..............._(�:JS.. ........................ 196.0.
To
You are hereby autho ' ed t connect the 9ASymice for. ,
J
Owner or Tenant .... - ...... ffP- C! . ........
At... ./-.033 .-:-`7,�e - ..-- -
New Service ........ ..............
....
No. of Meters ---..�........------- Reconnect ...........................
Move Service .................
No. of Add. Meters .............. Move Meter ..........................
.....................
..
PLUMBI�&SR
110 1/60-500