316 (2) /D543,01 LOT NO. / O
NO. STREET. -
21 5 &,AGASA N FOR PERMIT
O ERTINO`
topc'
Date �19 Permit No. 4;
TbTts Ef� rNeU b.Ellel Fee $ /
Applica I h y t �f 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.
BLOWER FURNACE
N
v
BETTER CUPERTINC HOMES
Use of Premises IBL:: c^moi
^I SAN CARLOS SHEET t+iETAL WKS.-
Owner
KS:Owner .779 OLD COUNTY RO.ASdWsS CARLoS
By Address
CONTRACTOR, AGENT
Phone Approve
P. MBING INSPECTOR 7r�
1
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating-Heaters
Blower Furnaces
Gas Fired Boilers
Warming-Ovens
-Percolators
Griddles
Steam Tables
Gravity Furnaces 11
Suspended Unit "
Floor Furnace
Miscellaneous
NAME TYPE)
pp lance Fees
inspected and Approved ...L4. L . .i...-- -
DATP. INSPECTOR -
HOUSE GAS PIPING
Number of Outlets - - j :Size of Main
GPng Fees - ,1 ._
Tested and Approved ......... ...::....... ..................................... .....
DATE INSPECTOR
i.
OFFICE
GAS SERVIC , NOTICE, copy „_
BUILDING INSPECOR'S'OPFICL 3C''
I CITY OF CUP TINO
7.
S .... ........... ....... _ . . . 19!.. r 1
`
To 0. — 59 ,
' YOU are hereby,authorized,to connect theGAS service for
4g
l,r Owner or Temnt {jft.03* GFlFv°t{E7F�E .:i` 'rr. .. ............ . . .? )=a
L
r New'Service ............................
No. of Meters, ,), •" - "
..... Reconnect - xG
.ti
� 'Move Service. ,..
No.,of Add "M' : 5
eters" ...... - •Mote Meter
i
St
PLUMBING, INSPECTOR 4 i
r M.a