51145 (3) ll/SA/ K�/✓bP�i�f6`J LOT NO. '-
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NO. T
m I ION FOR GAS PERMIT
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OF CUPERTINO
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0 ' Date 196— Permit No.
3 w0 CthPF�RTINO Fees / 5�
' 0 CI11plica ton is ere y 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
> and/or appliances in accordance with the provisions of the Plumbing Code of the City
Z m of Cupertino, and all other laws applicable thereto.
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a UState License 3 C- 2 J o YO 7 Approved urrr t r n„ .. .-. ,.-I{
jl Imo/ PLUMBING INSPECTOR /
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Remarks (Check ✓)
Type of Appliance Units Fees I� New Replace Relocate
Gas Ranges
Wall Heaters
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers
Warming Ovens
Percolators
Griddles
Steam Tables
Gravity Furnaces
Suspended Unit _
Floor Furnace
Miscellaneous
NAME TYPE)
HOUSE GAS PIPING
Number of Outlets Size of Main
Gas Piping Fees
Tested and Approved ................._.....,........_.......... ..................
DATE INSPECTOR