2199 (2) • /+ I LOT NO,
NO. E7
T FOR GAS PERMIT
W z E
CUPERTINO
rd AR 5 1963
3 i Date 196_ Permit No.�t Ck 9
zU CITY OF f� F;RTI�VO Fee-$
' o App [cation is here ma a to t e City of Cupertino for a permit to install gas pipes
O iand/or gas appliances as listed on the reverse side hereof, and agrees to install said pies
W and/or aepliances in accordance with the provisions of the Plumbing Code of the City
i
zW of Cupertino, and all other laws applicable thereto.
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0 o State Licens `f Approve
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Remarks (Chale ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges
Ralf Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Gri les
Steam Tables
Gravity Furnace
Suspen c Unit
Floor Furnace
Miscellaneous
:•(NAME TYPE)
HOUSE GAS PIPING
Number of Outlets J6 1 Size.Of n
Gas Piping Fees �1
Tested and Approved ._......��. . T t�� •..............•
D Ta INSPECTOR
Multi-House Gas Inspection Card
Gas Permit No. ....................................
GAS PIPING APPLIANCE FURNACE
APT. TESTED AND INSPECTED AND INSPECTED AND
NO. APPROVED APPROVED APPROVED
1. .
2.
3.
4.
5.
6.
7.
S.
9.
10. ,
11. - -
12.
13.
t4.
15.
1C.
'l7.
18.
19.
•20.
21.
22.
.''23-
124.
„25.
118 1168.500