618` v _ •nu n1 we r t�
APPLICA ON FOR Al'-PERMIT
9959
f .J UL I J CITY OF CUPERTINO
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Y.
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Date?rr 195_ Permit N
Vt t t jurtt I.1 rp s
, . ' Fee•$
Application is hereby made to the City of Cupertino fora permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
and/or appliances in accordance with the provisions of the Plumbing Code of the City ;
of Cupertino, and all other laws applicable thereto.
SM
Use of Prc
Address
Approved
PLUMBING INSPECTOR
Type of Appliance I Units Fees II
Remarks (Check ✓)
New (Replace Relocate
Gas Ranges
`{
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas ,Fired Boilers I J I�
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit 1
II i i
Floor Furnace
i� I
Miscellaneous
NAME TYPE)
pp lance Fees
Inspected and and Approved ----------- ?'.'j-
............. .... ....... ..... .......... .......
HOUSE GAS PIPING
Number of Outlets Size of Main���
Gas Piping Fees �' {
TestedandAPPr�..............................................................
TATE INSPECTOR