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1267 �© 7d -(ZRes :r)W No _ JANP� A Ip FOR GAS PERMIT C 6FF C'UPERTINO Da , g�2J Permit No. /& L7 � Fee Application is hereby made to the City of Cupertino for a permit to install gas pipes and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes and/or appliances in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all r laws applicable thereto. u c Use u � Addres Addres °; cro]t ybI; . L Pho �J'S� 8`6 1 Approved 1 PLUMBING INSPECTOR Remarks (Check ✓) Type of Appliance I Units Fees II New Replace Relocate Gas Ranges Wall Heaters Gas Plates Circulating Heaters � �� Blower Furnaces Gas Fired Boilers Warming Ovens Percolators Griddles I I II Steam Tables Gravity Furnaces Suspended Unit �I Floor Furnace liscellanenus � � j (NAMC TYf'G� Appliance Fees �I I Inspected and Approved ..............:...j................................................ DATE. INSPECTOR HOUSE GAS PIPING Number of Outlets Size of Main _ Gas Piping Fees Tested and Approved .. . . ��.....�.. ... ........ .............:............. DATA INSPECTOR