607 (2) G''-J S ' } TRB `� ,`L LOT NO. S`NO.
A�PPLtCATION FOR GAS PERMIT
I LA
ITY OF CUPERTINO
!Sri,
l �Q /
Date J 195_ -Per No.----
Fee
fU
CITY OF CUPERTINO Fees s�'
Application is hereby made to the City of Cupertino for a permit to install gas pipes
' n 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 other laws applicable thereto.
N -
�� `Use of Premises I,
- i
By Address
CONTRAC R, AGE �,!
Phone Approved <L�
PLUMBING INSPECTOR -
Remarks (Check J) .
Type of Appliance I Units Fees II New Replace I Relocate
-Gas Ranges I I I
Wall Heaters I I
Gas Plates I I II
Circulating Heaters II I I
Blower Furnaces
Gas Fired Boilers
Warming Ovens I • I
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
1-4 I II
Miscellaneous I I I�. I i Ow '
NAME TYPE)
I ' I II I I
I I II I I
pp lance Fees
Inspected and.Approved ..............:...
v DATF INSPECTOR
HOUSE,GAS PIPING
Number of Outlet's I I Size of Main I '
Gas Piping Fees
. Ttsted and Approved /Q- �.,...-I.. .. .....
ATE INSPECTOR