2201 /D v LOT NO
tT N FOR GAS PERMIT
WZ OF CUPERTINO
r,o MAR 5 1963
LL ✓�
3 u D 196— Permit No.UUpgM n OCO
= LL Fee•$
' 0 Application is hereby made to the City of Cupertino for a permit to install gas pipes
o i and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
'N` and/or appliances in accordanm with the provisions of the Plumbing Code of the City
z
z m of Cupertino, and all other laws applicable thereto.
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Use of Premi
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io State License4.4� Approve
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Remarks (Check r)
Type of Appliance Units Fees New Re place Relocate
Gas Ranges
\Vall' Heaters
Gas Plates
Circulating Heaters ,
Blower Furnam
Gas Fire Boilers
Warming Ovens
Percolators
Gri les
Steam Tables
Gravity Furnam
Suspen a Unit
Floor Furnace
Miscellaneous
(NAME TYPE) '
HOUSE GAS PIPING
Number of Outlets Size of M in
Gas Piping Fees �.
Tested and Approved�...... ................... .......
DAT. INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
'4 GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND 1 INSPECTED AND
NO. APPROVED APPROVED APPROVED
1.
2.
I
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13:
M.
15.
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73--
. 24.
3. 24.
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718—1/63-500