2024 (2) LOT NO.
NO. STREET
0" ON FOR GAS PERMIT
Datefp G.� OF CUPERTINO
2 s 1962 195_ Permit No.
� r(; {Y/ onf� CL n'� Fee E
Tp�pPrtaton'is herbPERIt'o 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 other laws applicable thereto.
c
Use of Premises
v
�n Owner Address
By Address .
ENrI
Phone i Approve
I PLUMBING INSPE R
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
.,j&Grawt Tables
nates
3 'nrled Unit=I �
Floor Furnace
Miscellaneous'
RAME TYPE
pp lance F 1 I I
Inspected and Approved ..............:... ...............................................
.
pATF. INSPECTOR
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Testedand Approved ........................ ...............................................
DATE INSPECTOR