2313 T J - � -5
NO. STREET
APPLICATION FOR GAS PERMIT
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z `— -! ' CITY OF CUPERTINO
3j D196- Permit No.
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�' plication I�hereby�made to the City of Cupertino for a permit to install gas pipes Iltl
o < and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i- and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all other laws applicable thereto.
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Use of Premises -: yWz ee
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O CONTRACTOR,AGENT
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State License , -Approved
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PLUMBING INSPECTOR
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Remarks (Check V)
Type of Appliance Units Fees I New Replace Relocate
Gas-Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
f
" ired Boilers
ing Ovens
_cola`fors '
-'Gfiddles
Steam Tables
Gravity-Furnaces
Suspended Unit
Floor Furnace
i
< Miscellane,,nrs
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees 12.111
Tested and Approved .......... ............. ............._......._........................
DATE INSPECTOR