2584 (2) LOT NO.- o2
NO. STREET - --J
§ A ,P C�I�ION FOR GAS PERMIT
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SE 18 9963 �y
3 a , Date 196_ Permit No. `�,'S/
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n0 C� i licdti3rt is'�(�h'efr�i�R�d NQhe City of Cupertino for a permit to install gas pipes
0 < and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
i1- and/or appliances in accordance with the provisions of the Plumbing Code of the City
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< w of Cupertino, and all other lawns applicable thereto.
Use of Premises
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CONTRACTOR,AGENT
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0 2 State License I Approved
p U PLUMBING
Remarks (Check J)
Type of Appliance Units Fees I New Replace Relocate
Gas Ranges
IVall Heaters
Gas Plates
Circulating Heaters
.Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
team Tables
Gravity Furnaces
Suspended Unit
Floor Furnace
Miscellaneous
(NAME TYPE)
SO
HOUSE GAS PIPING
I Number of Outlets Size of Main
Gas Piping Fees
"Vested and Approved ... .... ......... .. .... .................
DATE. INSPECTOR
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