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2024 LOT NO. NO. STREET 0" ON FOR GAS PERMIT Datefp G.� OF CUPERTINO 2 s 1962 195_ Permit No. � r(; {Y/ onf� CL n'� Fee E Tp�pPrtaton'is herbPERIt'o the City of Cupertino for.a 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. c Use of Premises v �n Owner Address By Address . ENrI Phone i Approve I PLUMBING INSPE R Remarks (Check ✓) Type of Appliance I Units Fees II New Replace Relocate Gas Ranges Wall Heaters Gas Plates Circulating Heaters Blower Furnaces Gas Fired Boilers Warming Ovens Percolators Griddles .,j&Grawt Tables nates 3 'nrled Unit=I � Floor Furnace Miscellaneous' RAME TYPE pp lance F 1 I I Inspected and Approved ..............:... ............................................... . pATF. INSPECTOR HOUSE GAS PIPING Number of Outlets Size of Main Gas Piping Fees Testedand Approved ........................ ............................................... DATE INSPECTOR