2820 (2) LOT NO.
APPLICAT
&0N FOR GAS PERMIT
" < MAY 7 1964CIF CUPERTINO
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o U Date CITY OF CITINO— Permit No. rid ay
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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
i m and/or,appliances in.accordance with the provisions of the Plumbing Code of the City
a of Cupertino, and all other ws ap licable thereto.
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Use of Premises
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3 Owne Address
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O O NTRACIOA,AGENT
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State License _ Approved
Remarks (Check J
® )
TT.ype of Appliance Units Fees II New Replace Relocate
as Ranges
all Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit
Floor Furnace I
Miscellaneous
(N E TYP
5
HOUSE GAS PIPING
Number of Outlets Size of Main
ng Fees
Testedand Approved ........................ ...............................................
DATE INSPECTOR
e
Multi-House Gas Inspection Card
Gas Permit No. ..........................---.....
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED PR APPROVED
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