2816 �03y��` COT NO. I/
NO. 0 S
C ION FOR GAS PERMIT
W Z D STI OF CUPERTINO
I MAY 7 9964 u fl
° < Date 196_ Permit No.e <
W , 1`' dao
° cat%d is pe7�6y made'to the City of Cupertino for a permit to install gas pipes
o Q' and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
is and/or appliances in accordance with the provisions of the Plumbing Code of the City
< of Cupertino, and all o e laws applicable thereto.
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Use of Premises _
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O O AGENT
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oStat License Approved
—U PLUMBING INSPECTOR
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Type of Appliance Units Fees New Re lace Relocate
Gas Ranges
11 Heaters
Gps Plates
Circulating Heaters
o°ower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous
(NAME TYPE)
O _—
HOUSE GAS PIPING
Number of Outlets Size of Main
(Tas Piping Fees
Tested and Approved .':..'�.�..�..�..... . .. ......................
'nATE INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
1.
5
7.
If
9.
10.
1.1.
12.
1��3•.
14.
15..
1<,
17.
18.
19.
20.
2 .'
21.
24,
25.
116/1/63.500