2817 —
NO0 TR
ON FOR GAS PERMIT
z a OF CUPERTINO
o MAY 7 1964 ' ^ p
° a Date 196— Permit No.0�0
3 CITY OF CUPERTINO Fer$S
° Application is hereby made to the City of Cupertino for a permit to install gas pipes
o Wand/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i a and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and a of er laws a Iplicable thereto.
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F F
LL Use of Pre ISeS
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3 Owne A Address
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oStat Licens Approved
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C PLUMBING INSPECTOR
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Remarks (Check J)
Type of Appliance Units Fees I New Replace Relocate
Js Ranges
Wall Heaters
&as Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Stearn Tables
Gravity Furnaces
Suspen a Unit
oor Fi WOW
urnace
Miscellaneous
NAME TYPE)
it
3 HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ........................I................................................
DATE. INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
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118 1/63-500