2449 (2) NO. STREET
APPLICATION FOR"GAS?PERMIT
z ' _CITY OF CUPERTINO
LL
3 a Date Permit No. `_ s
U
W LL - Fee $ J 10
Application s-is'hereby made to the City of Cupertino for a permit to install gas pipes
o a and/or gas appliances as listed on,the'reverse:side hereof„and agrees to install said pipes
Iand/or appliances'in accordance•with.the provisions of,-the Plumbing Code of the City
s w of'Cupertmo, and all other laws•applicable thereto:-
d x -r
r- .• 4.lge
� 4 Use of Premises �rTt(51P.0 te.f..tT
00 (/�
4 > 3 Owner LU1' [Eff.AW \ Lf t%RC{f Address
” z , By µJIG TIJG. Address Pd`Lta11 54M
O CONTRACTOR,AGENT �iupl •{s'I i.i0 T'�,
- < Phone
i w z
i o State License 21 2I Approved
U 1
PLUMBING INSPECTOR
� N
Type of Appliance Units Fees Remarks. (Check ✓)
II New ' Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
_ Blower Furnaces
Gas Fired Boilers 3
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
.Floor Furnace !
.Miscellaneous '
�-QaC.1G11TER.. �
[l01'tFi•G G
_Inrt&v4 INA IF-m- I
Ry ! N 1
HOUSE GAS PIPING
Number of Outlets N Size of Main _
Gas Piping Feesj.�'
Teited and Approved .yam. .. ...'':T. .......�L�!./. ..........�.._- ----
DATE �/ INSPECTOR