2616 LOT NO.
APMI Tp'O, N FOR GAS PERMIT
w = �NUV 5 1963 :�.a )OF CUPERTINO
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3 U DatenT�_II �t l' An'\�(lP6_ Permit No. d
Fee-$_ao 0
O Application is hereby made to the City of Cupertino for a permit to install gas pipes
o a 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
< w of Cupertino, and all other laws applicable thereto. -
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Use of Premises
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0 3a Owner b-...L� n mo Address
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O �N7atACTOR,AGENT
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o State License Z i Approved
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PLUMBING INSPECTOR
Remarks (Check ✓1
Type of Appliance Units Fees II New Replace Relocate
was Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Jnit
Floor Furnace I
Miscellaneous
,(NAME TYPE)
9 HOUSE GAS PIPING
Number of Outlets Si of in
as Piping Fees
Tested and Approved a-, .. .. .....................
OATP. I s OR
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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