2081 QOT NO.
FOR GAS PERMIT
i i ® C .,CUPERTINO
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RLL ���OY 1 9 �96� l Permit Na. �t /
° 'a Date
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° App&fy i��rel�f{� y of Cupertino for a permit to install gas pipes
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a and/or gas applian2`ds as'tistlt�frse side hereof, and agrees to install said pipes
i m and/or appliances in accordance with the provisions of t e Plumbing Code of the City
a w of Cupertino, and al r laws ap able thereto.
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Use of Premises Z
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0 w tate License// Approved
—0 CONTRACTOR. AG 'T /
Remarks (Check 0
Type of Appliance Units Fees II New Replace I Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Grid les
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved .......� .--.��...�.. ... ... . . . . . .........:.......
DATE INSPECTOR