2819 NO EE
FOR GAS PERMIT
` D CI i OF CUPERTINO
wz
MAY 7 N6
TM4 T
9 3 ¢ Date 196_ Permit No.—c2O l
URTINQ Fee k;l
' o AgI a ionTsFIherel>y made to the City of Cupertino for a permit to install gas pipes
o < and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i m` and/or appliances in accordance with the provisions of the Plumbing Code of the City
a w of Cupertino, and all o er laws a plicable thereto.
w x
F r
w Use of Premises
00
3 Own ddress
zJ =4
o y ddress
3 r o CLO ,A ENT
— Phon
w z
0o State Licens Approved
4
Remarks (Check ✓)
Type of Appliance Units Fees II New Replace Relocate
Gas Ranges
Wall-Heaters
Gas Plates
Circulating Heaters _
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspeniled Unit _
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
f'GasPiping
f Outlets Size o
Fees Approved � :AINSP=ECTOR
DATE
Multi-House Gas Inspection Card
Gas Permit No. .-..................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED AP APPROVED
2.
5.
6.
7.
8.
9.
TG.
t t.
12.
13.
15.
1 6.
17.
18.
20.
21.
22.
23.
118 1/, 3.500