Loading...
1549 (2) LOT NO. �a NO. STREET ® N l*R GAS PERMIT e 1C❑Icl']' p)jF,[CUPERTINO Anr 6 IJt1� Eat. Date , 195_ .Permit No. X. n CITY. OF, CUPERTINO Pee ate? 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 provisions of the Plumbing Code of the City CJ of Cupertino, and all other laws applicable thereto. u 6 :a Use of Premises o ,zeza ' C Q rn Owner �SOA7�L_n fhirsio.l °a41 �faAddress Cis iSs�l% — By 64A4 CONTRACLOR AGENT Address Phone F P" P— ��� Approved , PLUMBING INSPECTOR Remarks (Check ✓) Type of Appliance I Units Fees II New Replace Relocate Gas Ranges 1 4 Wall Heaters Gas Plates CirculatingHeaters Blower Furnaces Gas Fired Boilers Warming Ovens Percolators 11 Griddles Steam Tables Gravity Furnaces Suspended Unit II Floor Furnace NEW Miscellaneous � � i� . (NAME TYPE) I I I p0 lance Fees I I II I Inspected and Approved -------.......:... ............................................... . DATE INSPECTOR HOUSE GAS PIPING Number of Outlets a Size of Main 3T— Gas Piping Fees ;?- -�— — Tested and Approved . . /O.h........ .... ........................... ATE INSPECTOR