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2813 (4) as - � ^ '- OT NO. n EE C A ON FOR GAS PERMIT W z TMAY 7 19Va C OF CUPERTINO sp y O l3V Date T � ,l�{i Permit No. Fee $r13 00 4 w 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 is and/or appliances in accordance with Ithe prov'sions of the Plumbing Code of the City . a w of Cupertino, and all other law applicable t eto. w I t � a Use of Premises 00 3 Owner Address oa 2J t o By Address 3 F CONTRACTOR, EN — w Phone — s W z oState License Approved � t PLUMBING INSPECTOR NewReplace cc ✓1 Type of Appliance Units Fees w Re placlace Relocate Gigs Ranges Wall Heaters Gas Plates iculating'Heaters _ Blower Furnaces _ Gas Fired Boilers Warming Ovens Percolators _ Griddles Steam Tables Gravity Furnaces Suspended Unit Floor Furnace Miscellaneous NAME TYPE) j HOUSE GAS PIPING Number of OutletsAS17, F Main s.Gas Piping Fees .oTested and Approved ... .....�. . ................. TE ltolr INSPECTOR Multi-House Gas Inspection Card Gas Permit No. ..............-.................... GAS PJAND APPLIANCE FURNACE APT. TESTEDINSPECTEDAND INSPECTED•ND NO. APPROP D APPROVED 4. 5. H. 9. lo. �1. I'2. 13. 14. 15. 16. 17. 1 H 9. _1. 22. 23: 24. 25, 118 1/63-500