2082 7
T NO. I
P�PL�it FOR -GAS PERMIT
W CITY OF CUPFRTINO
0O
y
0 u Da ® l 196— Permit No.
Fee.$ s�
° ic Q� is e t he City of Cupertino for a permit to install gas pipes
o a anc� asQliaj � a reverse side hereof, and agrees to install said pipes
i N and/or appliances in accordance with the provisions of the Plumbing Code of the City
¢ m of Cupertino, and ar �aicableereto.
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Use of Premises
00
3 Owner Address
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J p y Address
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a State License Approved
CONTRA R, AG NT
Type of Appliance Units Fees Remarks (Check 0I 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
nivFloor Furnace-"
Miscellaneous
NAME -rYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ...7.._...:.-.... .. . . . .T,0R ......
DATE INSPECTO0.
FL
CA
M.-
: � � , �\ � ) § �
00
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