1090 (2) Lor NO.—
STREET)
o.STREET _ ..
W-0 oAl l ICXTION FOR, GAS PERMIT
ite ice '
_ CITY OF CUPERTINO
` i-T Date 95_ Permit No.
Fee .
Application is hereby made to the City'of Cupertino for a permit to install gas pipes
ao-i, 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.'
a of Cupertino, and all other laws applicable thereto.
y*I7 •N -
.I t
'aA' r Use of Premises 1 G A nTr AA Int_`V LS_�N G'
f' (n Owner ` Address��- L
o=, • gyJOE AMARAL PLUMBING, 'Address
ZMR TJdrroKAMWA
Phone SANTA CLARA, CALIFORNIA - Approve
- PLUMBING INSPECTOR
, t
. Remarks (Check -7)Type-of Appliance Units Fees II New Replace J Relocate
Gas Ranges
Wall,Heaters I I
Gas Plates
Circulating HeatersY-
Blower Furnaces "�I••Y:* ;�.'r'._. I "-'.
Gas Fired Boilers 'I •`-
"Wg ming Ovens
Per olators I • I -
Griddles- ., I I .'
Gravity Furnaces
Suspended Unit
Floor Furnace I
_
=`4=1ouI II
_ Miscellanes'11
;, `I �.�' I •
NAME TYPE
t
- i
II II � VIII I II _
I I I I I
I I II I I
_-Appliance Fees
Inspected and Approved ........:...'.:_.I....._......... ....._.:---------......
DATE _ INSPECTOR
HOUSE GAS"PIPING
Number of Outlets I I Size of Main I fI
Gu Piping Fees I
Tested 'and Approved 7/-�-I - . .:....:....................
DA E INSPECTOR
1 .y
VrGAS SERVICE NOTI � >PYE
BUILDING INSPECTOR-.5.�OFF [jl- ,
CITY mECUPERTIN
r
You are.hereby authori d to connect the G v+ce for -
III �- •.
I.
Owner or Tenant'--- ........:.`..P%.�.f...-..:.. . -
r.
At .....If�.x
.: New Service
No. of Meters ....... .._...,..... Reconnect ......?::.._.' `
Move Service...................
No. of Add. Meters .............. �:Move Meter ...................
P BING''•INSPECTOR
110 1160-500 :