1282 (2) .* G /� 1 `•'�F`.. C r- 1 ! .".. GOT NO.
STREET
APPLICATION FOR GAS-PEWIT
CITY OF.•CUPERTINO t
•Date lA- Permit No.
Fee $
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/oi appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
C L[ r
Use of Premises._ I
Cn •Owner _ Address
By - Address s +�
CO ACTOR, AGENT
A roved '7'
Phone 75 5-7,Y' - _ PP PLUMBING INSPECTOR at j
/ • Remark's (Check'✓)'�,
Type of Apphanc'e 'I Units Fees'll New (.Replace 'Relocate
Gas Ranges 1 ..I.• .I :. �t��� •.+� ''� I
Mall Heaters T II
Gas Plates
Qrcubting Heaters
glower Furnaces
as Fired Boilers _ „-� ''<•
arming Ovens _
colators
fiddles
Steam Tables -
Gravity Furnaces
Suspended Unit II
Floor Furnace _
Miscellaneous
NAME TYPE)
I I II I I
Appliance Fees
Inspected and Approved ....:.........:...!
DATE. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees ,I
Tested and Approved -. . .. !!i . -. /' ^...........................
DATE INSPECTOR