1065 (2) LOT NO
STREET "N.: i. .�'1'!•�.- /.
..: 12,1960
i4PPLIC TION FOR GAS PERMIT "
rTr' FRT TY OF CUPERTINO
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Date ", t95_ Permit No._���_'
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-Fee$./ s i
jApplication is hereby made to the City of Cupertino for a 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 other laws applicable thereto.
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a Use of Premises ' 1—F A!f��ItppAI Y RESIDENCE "
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iOwner ddress
By�gi pMARAL PLU B Address
�` 4pt7RNIA".
Phone 6AN aaR'CJCi Approved Che
I
-I PLUMBING INSPECTOR J
• Remarks (Check J) '.
Type of Appliance I Units Fees II New Replace Relocate
Gas^Ranges
WARIL-iters II
Gas"Plates ,
Circulating Heaters - .� �•
Blower `F6rnaces . J L I '
Gas Fired Boilers
Warmirig`Ovens,
V
Percolators
_Griddles'.
Steam Tables 'I - II
Gravity,Furnaces f
S:upendedUnit 1. 'II
.Floor'Furnace
�'Miscellaneous
NAME TYPE)
pp lance Fe—es I I II
Inspected and Approved ............:::... ....... .........:...................
...._.,..
DATE INSPECTOR
.HOUSE GAS'PIPING
Numbee,of Outlets � .. �. Size'of Main �,
GaiPIping FFees
Tested and Approved " . . . .... .... �..
— ... . ... ...... .......................
O/G...
DATE '- INSPECTOR
33 GASSERVICOp
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BUILDING, INSPECTOR'S_OFICE•
' CITY�:OP CUPERTINO
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You are hereby auth t connect the s ice for
..� .. . , ............. �4�....... .... yY}...
Owner or Tenant .. . - .....- . ... 't!.��.�!�% C `
•
:
:At
_day`? -.`. ... ... ... .................. ... .................................. ----------
- y �.+�„v,. ="^•`` '- ew Service .........
.........
v
'- No:of Meters ,. ' Reconnect r
Move Service . ...............:+:.:?
--
t :' .'�'No. of Add. Meters ............. __y
r:•+n .. -
. .. . ...
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PLUMBI'iVG.,+INSPECTOR�-
. 110 1/60-'500
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