2764 20900 �;„SC,gvens Creek Slvd.
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VARPP,p A N FOR GAS PERMIT
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X�1QL4 CUPERT�610. Permit No X7.6
Date.
�i
Fee $
NApplication is hereby made to the City of Santa Clara for a rermit to install gas pipes
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.4; and/pr gas appliances as listed on the reverse side hereof, and agrees to install said pipes
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and/or appliances in accordance with the provisions of the Plumbing Code of the City
u of Santa Clara, and all other laws appitcable thereto.
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a Church
Use of Premises ............................................................_........_....__.__....... ...............
_._..
C.
Cn
Glen Rutt 11741 Sharon Drive
Owner .................._..___....---......-----.. ...... Address ....11741. -..........
By Winchester Plumbin Address 17 ell Ave.
CONTRACTOR, AGENT
Phone ............._3_ _$..-7.6,15................ Approved .._...... .............
PLUMBING INSPECTOR
Remarks (Check V)
Type of Appliance Units, Fees New Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates I II
Ciiculating Heaters I
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit -
Floor Furnace I II
Miscellaneous I
NAME TYPE)
i. -1 ii
II
_ � n 19D II I I
I v II I I
App Fees
Inspected and Approved I........_...................._...-----------
DATE INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of rain
Gas Piping Fees
Tested and Approved .... #.I.. S .........
........................
I INSPECTOR