2713 LOT NO.
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APP C TION FOR GAS PERMIT
EB 2 8 1964 OF CUPERTINO
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° Application is hereby made to the City of Cupertino for a permit to install gas pipes
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gas appliances as listed on the reverse side hereof, and agrees to install said pipes
im 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.
Use of Premises lets vC—/✓C
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I State License Approved
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PLUMBING INSPECTOR
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 Unit
Floor Furnace
Miscellaneous
=TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main „c
Gas Piping Fees
Tested and Approved . ..................._. ........................_......................
DATE INSPECTOR