2514 Y�c LOT NO.-
NO.
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PPI ATION FOR GAS PERMIT
i VA4 Tl OF CUPERTINO
wO uDUG 16 1963 �• ' 196— Permit No.
xo +.. Fee$
A pli� n{3�err ade to the City of Cupertino for a permit to install gas pipes
o a arM/b�gas a plia5tces as +sfe°d on the reverse side hereof, and agrees to install said pipes
> +- and/or appliances i cordance with the provisions of the Plumbing Code of the City
a w of Cupertino, an II of r laws ap ' ble thereto.
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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
(NAME. TYPE)
HOUSE GAS PIPING
Number of Outlets Size of MV
Gas Piping Fees J
Tested and Approved <2r.yTr.... .........
•..•
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