1743 - GASsa �
LOT NO.
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1.10N. FOR GAS PERMIT
�A� �� CI OF "CUPERTINO
Date 1` 195— P it
CITY OF CUPERTINerm
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1-4
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No. 1-7 T
Fee $ CQ
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Application 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 ther laws applicable thereto.
Use of PrWises y C'e 41 .0*11
Owner Q — T 1 S Address
Address
ress
r1
CONTRACTOR, AGEN'P
Phone G10 � y2 Approv s�
PLUMBING INS CT R
of Amliance I Units Fees
Gas Ranges I II I
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
GaBoilers
Warming Ovens f ��
Percolators
Griddles
Steam Tables
Floor Furnace '
. . -- t—
M` cellaneous
i1AME TYPE
Inspected and Approved
..............:...
:.
DATE INSPECTOR
]
HOUSE GAS PIPING
�4r1
Number of Outlets
Size of Main
Gas Piping Fees
Tested and Approved .............
..........1...................... ..............--
D TE INSPECTOR
09
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