747 (2) STREET
RgL FOR GAS PERMIT
® ( '� F CUPERTINO
Date 259 ! Permit No.
� Fee $ � • ��
r;F �:�1P�RT�fif�
App 11'at�ion 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 provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
H
Use of Premises
u cA
a .,. _ �,
05Owner•asrn t.+t��.+ an .► wi.� Address .d
�/�t n .... as/ri
_ ...Yto
AddressAN OC'AGENT 0�. .,:. ,Ph -OHQNt CH 2-3 !.ct Approved
PLUMBING INSPECTOR
Remarks (Check d), ;
Type of Appliance I Units, Fees II. New _;I Replace'IiRelocate
Ctas Ranges
Wall Heaters �
Gas Plates4°E`
Circulating Heaters
Blower Furnaces
Gas Fired—Boilers
Warming Ovens
Percolators
Griddles �� 0. -1
Steam Tables
Gra6ity Furnaces �•, �� y�q•�.i. _.`'V{
Suspended Unit
Floor Furnace
Miscellaneous : '� it • , r.
(NAME. TYPE �� •','". i'+: '�I.r 7�.f
r . .
^p lance Fees ;. —
},
Inspected and Approved ....:.:..._:.,...1.�:... ••'- ' �}`- � I'
DATAr •.INSPP.CTOR
HOUSE GAS PIPINGNumber-of Outlets Size of"Main
Gas.Piping s r ... . .,.! �INSPECTO
Tested and Approved
��n ERrVICTICE
° E- GAS SOPY
BUILDING INSP$gOROPICIi
CITY OF,jC ER NO
To ..
You are hereby authorized to connect the GASsery ice'for
+ Owner or Tenan
At.
New Service ..................
No. of Meters ... ................. Reconnect ............r.:...............
ry + ,.
Move Service -----------------
No.
---............No. of Add. Meters .............. Move Meter ...................,.
K fi e. 4i y • .l
%IN
f-Alr -o ' .. 4 t •0" PLUbIBIPG INSPECTOR
1M
110'3(60 S00 , }n jF� t> ...0 xyr e'' nor•