1527 LOT NO,
NO. STREET
4=�a11�PVJ ION FOR GAS PERMIT
�cI OF CUPERTINO
Date 'JAN 101962 5— Permit No.
CITY OF CUPE�TINVO F"
Application is hereby t e o he City of Cupertino for a permit to install g pipes
` and/or gas appliances as listed on the reverse side hereof, and agrees to install sai pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all r laws applicable thereto.
:a
Use f remises
L
C Owne O'er Address
By Address — r
CO TR CTOR, AGP.NT
Phone — — 1 APProv,
PLUMBING INSPECT00.
Remarks (Check ✓)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Uni[ � � I
Floor Furnace
Miscellaneous
NAME TYPE)
Appliance Fees
Inspected and Approved ..... ........:... ......................._...._..... .........
DATF INSPECTOR
HOUSE GAS PIPING
Dumber,of Outlets Size of Main
Gas Piping Fees
Tested and Approved ........................ ...............................................
DATE INSPECTOR